title: Pacemaker placement and shoulder surgery: is there a risk?
abstract: BACKGROUND
  Surgery to the anterior aspect of the shoulder is performed by many surgical specialties but the techniques used by our cardiology colleagues for insertion of cardiac pacemaker wires are often not appreciated by the surgical community. The deltopectoral approach has been  used for open pacemaker wire insertion for many years by cardiologists.
  
  
  METHODS
  We surveyed a group of subspecialty shoulder surgeons as well as orthopaedic trainees to see if this approach for pacemakers is well recognised. We tried to assess what level of knowledge exists regarding pacemaker  placement in general as well as specific risks.
  
  
  RESULTS
  There appears to be a paucity of knowledge regarding pacemaker placement and related patient safety issues in both surveyed groups. There was no difference between the two groups, suggesting that the level of knowledge does not increase  with experience and specialisation.
  
  
  CONCLUSIONS
  There is the potential to cause harm to patients if the insertion site and type of device is not identified before commencing surgery in this region and steps must be taken to minimise any intra-operative risk. There is a risk from direct  injury to the pacemaker and/or leads as well as the hazards of using diathermy in close proximity to a pacemaker. There must be more widespread dissemination of this information in order to minimise risks to patients with pacemakers in situ.
authors.affiliation: Royal Free Hampstead NHS Trust, UK.
authors.forename: P M
authors.initials: PM
authors.lastname: Ahrens
authors.forename: N A
authors.initials: NA
authors.lastname: Siddiqui
authors.forename: R D
authors.initials: RD
authors.lastname: Rakhit
mesh_terms: D002309:Cardiology / Q000592:standards*; D003253:Consultants; D004564:Electrocoagulation / Q000706:statistics & numerical data; D006801:Humans; D009985:Orthopedics / Q000592:standards; D010138:Pacemaker, Artificial; D061214:Patient Safety; D011364:Professional Practice / Q000592:standards*; D012307:Risk Factors; D012782:Shoulder / Q000601:surgery*