title: A perioperative management algorithm for cardiac rhythm management devices: the PACED-OP protocol.
abstract: BACKGROUND
  Limited data are available regarding the perioperative management of cardiac rhythm management devices (CRMDs) exposed to intraoperative electromagnetic interference. We postulated that implementation of a simple, standardized approach to CRMD management using our own institution's Pacing And Cardioverting Electronic Devices peri-Operative Protocol (the PACED-OP protocol) would be associated with a reduction in the amount of device reprogramming without an increase in CRMD-related complications.
  
  
  METHODS
  Records of patients with CRMDs undergoing 497 consecutive surgical procedures were analyzed retrospectively. Roughly half (51%, n = 254) of these procedures occurred before implementation of the PACED-OP protocol, when patients were generally treated according to the American Society of Anesthesiologists' 2005 guidelines. These cases were compared to the remaining surgeries that occurred after implementation of the PACED-OP protocol. Records were screened for evidence of intraoperative CRMD malfunction that was directly associated with the use of electrocautery. Postoperative complications that could be indirectly or possibly linked to electrocautery-mediated CRMD malfunction were also identified.
  
  
  RESULTS
  Implementation of the PACED-OP protocol was associated with a significant reduction in the odds of device reprogramming (adjusted odds ratio [aOR] 0.19, P < 0.001). There was no direct evidence of CRMD malfunction in either cohort. The rate of postoperative complications that could be indirectly or possibly linked with electrocautery-mediated CRMD damage did not differ significantly between cohorts (aOR = 1.37, 95% confidence interval 0.56-3.3, P = 0.49).
  
  
  CONCLUSIONS
  The PACED-OP protocol implementation was associated with a significant reduction in the odds of device reprogramming without a significant difference in the odds of CRMD-related complications.
authors.affiliation: Department of Cardiology, University of Tennessee, Knoxville, Tennessee 37920, USA. wjmmd@me.com
authors.forename: William J
authors.initials: WJ
authors.lastname: Mahlow
authors.forename: Robert M
authors.initials: RM
authors.lastname: Craft
authors.forename: Nicholas L
authors.initials: NL
authors.lastname: Misulia
authors.forename: James W
authors.initials: JW
authors.lastname: Cox
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Hirsh
authors.forename: Carolyn C
authors.initials: CC
authors.lastname: Snider
authors.forename: Jerrin O
authors.initials: JO
authors.lastname: Nabers
authors.forename: Zachary A
authors.initials: ZA
authors.lastname: Dickson
authors.forename: Robert A
authors.initials: RA
authors.lastname: Muenchen
authors.forename: Dale C
authors.initials: DC
authors.lastname: Wortham
mesh_terms: D000368:Aged; D000465:Algorithms; D004564:Electrocoagulation / Q000592:standards / Q000706:statistics & numerical data*; D004868:Equipment Failure / Q000706:statistics & numerical data*; D004869:Equipment Safety / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000592:standards / Q000706:statistics & numerical data*; D019990:Perioperative Care / Q000592:standards / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013714:Tennessee / Q000453:epidemiology