When is an electrophysiology consultation indicated for 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

Answer

An electrophysiology consultation is always appropriate when there are uncertainties regarding perioperative management of CIEDs; however, it is particularly worthy of strong consideration in the following specific clinical scenarios:

  • Preoperatively, patients who are pacer-dependent or pacer-dependent with an AICD may require additional interrogation and reprogramming, as do patients in whom magnet placement interferes with surgical exposure
  • Intraoperatively, an electrophysiology consultation may be warranted if there are unexpected responses to magnet placement
  • Postoperatively, interrogation must be performed if magnet therapy or antitachycardic therapy was employed intraoperatively to ensure the return of baseline CIED function

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