How are the risks from electromagnetic interference (EMI) in the perioperative management of permanent pacemakers (PPMs) and automatic implantable cardioverter-defibrillators (AICDs) reduced?

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

Answer

If electrocauterization must be performed above the level of the umbilicus, the following specific interventions may be employed to reduce the risk of EMI affecting the CIED:

  • Use of a bipolar cautery drastically reduces the risk of EMI as compared with the use of a unipolar cautery, because of the local containment of current within the cathode and anode tips of the Bovie; this may be requested after consultation with the surgeon
  • If a unipolar cautery must be used, placement of the grounding pad as far away from the CIED as possible will reduce the risk of EMI; this is frequently achieved by placing the grounding pad on the lower extremities to direct the current away from the upper chest, where EMI is most likely to occur
  • Using the lowest effective current amplitude and delivering the current in short bursts (as opposed to long continuous applications) will also reduce EMI risk

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