title: Electrocautery-induced ventricular tachycardia and fibrillation during device implantation and explantation.
abstract: Electrocautery is commonly employed during surgical implantation and explantation of pacemakers and implantable cardioverter-defibrillators (ICDs). Four cases of electrocautery-induced ventricular tachyarrhythmias including ventricular tachycardia (VT) or ventricular fibrillation (VF) during device implantation or explantation are described.
  
  
  METHODS
  The incidence of electrocautery-induced VT or VF at Winthrop University Hospital was analyzed over a 5-year period (November 2000 to March 2006). Specific devices, indications for device implantation or explantation, electrocautery configuration, and grounding patch placement were analyzed.
  
  
  RESULTS
  Between November 2000 to March 2006, 4,698 devices were implanted and/or explanted at Winthrop University Hospital, of which 4 patients developed electrocautery-induced ventricular tachyarrhythmias. The patients had a mean age of 64+/- 16 years, and mean left ventricular ejection fraction of 34 +/- 9%. Three patients (75%) had severe coronary artery disease with prior myocardial infarction. Three patients (66%) had clinical hypertension. Three patients developed ventricular tachycardia during elective explantation of a malfunctioning device. One patient developed ventricular fibrillation during pacemaker implantation. Prior to each explant, the ICD was programmed off. Patients underwent explantation of a Medtronic Marquis model no. 7230CX ICD, Medtronic Marquis DR no.7274 and Guidant Ventak Prizm 2 model no. 1861. The mean age of explanted devices was 35 +/- 13 months.
  
  
  CONCLUSIONS
  This study demonstrates a 0.09% incidence of provoked sustained ventricular tachycardia or ventricular fibrillation requiring external defibrillation during device implantation or explantation. This occurred despite programming off the ICD prior to device replacement, positioning the grounding pad far from the pulse generator and the use of bipolar electrocautery. We hypothesize that direct current energy is delivered to the pulse generator, lead and/or connector and then to the myocardium. Staff should be aware of electrocautery-induced VT or VF during device procedures and be prepared to promptly cardiovert and/or defibrillate VT/VF should this scenario occur.
authors.affiliation: Department of Cardiology, Winthrop-University Hospital, 120 Mineola Blvd, Suite 500, Mineola, NY 11501, USA. lo@mad.scientist.com
authors.forename: Ronald
authors.initials: R
authors.lastname: Lo
authors.forename: Alexandru
authors.initials: A
authors.lastname: Mitrache
authors.forename: Weilun
authors.initials: W
authors.lastname: Quan
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Cohen
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D004564:Electrocoagulation / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D017180:Tachycardia, Ventricular / Q000453:epidemiology / Q000209:etiology*; D014693:Ventricular Fibrillation / Q000453:epidemiology / Q000209:etiology*