Application of radiofrequency energy in surgical and interventional procedures: are there interactions with ICDs?
During surgical and interventional procedures, interference may occur between ICDs and electrical cautery or with the application of RF energy. This may lead to the false induction of ICD therapies or could even result in device malfunction, which represents a potential perioperative hazard for the patient. This study analyzed the intraoperative interactions in 45 consecutive ICD patients in reference to different surgical and interventional procedures. A total of 33 surgical operations (general surgery [n = 14], urologic [n = 5], abdominal [n = 10], gynecological [n = 2], thoracic [n = 1], neurosurgical [n = 1]) and 12 interventional therapies (RF catheter ablation [n = 10], endoscopic papillotomy [n = 2]) were performed. The ICD devices were all located in left pectoral position and consisted of 25 single and 20 dual chamber defibrillators. During the procedure, tachyarrhythmia detection (VF 296 +/- 20 ms, VT 376 +/- 49 ms) of the devices was maintained active (monitoring mode), only ICD therapies were inactivated. The indifferent electrode of the electrical cauter/RF generator was placed in standard positions (right/left mid-femoral position [n = 27/8], thoracic spine area [n = 10]). After the procedure, the ICD memory was checked for detections and for changes in the programming. There was no oversensing, reprogramming, or damage of any defibrillator caused by RF energy. Despite the lack of undesired interactions, ICDs should be inactivated preoperatively to assure maximum patient safety. However, should inactivation not be possible, or the achievement uncertain, electromagnetic interference is highly unlikely.
Medical Hospital I, University of Munich, Grosshadern, Germany. Michael.Fiek@med1.med.uni-muenchen.de
Michael
M
Fiek
Uwe
U
Dorwarth
Ilka
I
Durchlaub
Sabine
S
Janko
Christian
C
Von Bary
Gerhard
G
Steinbeck
Ellen
E
Hoffmann
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002311:Cardiomyopathy, Dilated / Q000628:therapy; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation; D003327:Coronary Disease / Q000628:therapy; D017147:Defibrillators, Implantable / Q000009:adverse effects; D004574:Electromagnetic Fields; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015642:Radiology, Interventional; D017180:Tachycardia, Ventricular / Q000209:etiology; D014693:Ventricular Fibrillation / Q000209:etiology