How does pacer dependence affect the perioperative management of permanent pacemakers (PPMs) and automatic implantable cardioverter-defibrillators (AICDs)?

Updated: Oct 29, 2018
  • Author: Albert H Tsai, MD; Chief Editor: Sheela Pai Cole, MD  more...
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Answer

One of the most important steps during the process of evaluating a patient with a CIED for surgery is determining whether he or she is pacer-dependent—in other words, knowing what would happen to the patient if the pacemaker stopped working. This is crucial for anticipating electrophysiologic complications perioperatively. A patient whose cardiac output is reliant on a paced rhythm (ie, who is pacer-dependent) will not tolerate prolonged periods of CIED dysfunction; thus, alternative methods of pacing must be immediately available.

The first step in determining pacer dependence is to obtain a preoperative ECG. Because most patients are either completely (near 100%) or rarely (< 1%) dependent on their CIED, the presence or absence of pacing spikes on the ECG is strongly suggestive of their baseline pacing requirements. Additionally, the CIED interrogation report contains information on the percentage of the time that the patient requires pacing and can be used to confirm ECG-based findings. Finally, direct interrogation of the device can be performed to determine a patient’s baseline pacing requirements.


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