Initial Experience of an Anesthesiology-based Service for Perioperative Management of Pacemakers and Implantable Cardioverter Defibrillators.
BACKGROUND
Management of cardiovascular implantable electronic devices (CIEDs), including pacemakers and implantable cardioverter defibrillators, for surgical procedures is challenging due to the increasing number of patients with CIEDs and limited availability of trained providers. At the authors' institution, a small group of anesthesiologists were trained to interrogate CIEDs, devise a management plan, and perform preoperative and postoperative programming and device testing whenever necessary.


METHODS
Patients undergoing surgery between October 1, 2009 and June 30, 2013 at the University of Washington Medical Center were included in a retrospective chart review to determine the number of devices actively managed by the Electrophysiology/Cardiology Service (EPCS) versus the Anesthesiology Device Service (ADS), changes in workload over time, surgical case delays due to device management, and errors and problems encountered in device programming.


RESULTS
The EPCS managed 254 CIEDs, the ADS managed 548, and 227 by neither service. Over time, the ADS providers managed an increasing percentage of devices with decreasing supervision from the EPCS. Only two CIEDs managed by the ADS required immediate assistance from the EPCS. Patients who were unstable postoperatively were referred to the EPCS. Although numerous issues in programming were encountered, primarily when restoring demand pacing after programming asynchronous pacing for surgery, no patient harm resulted from ADS or EPCS management of CIEDs.


CONCLUSIONS
An ADS can provide safe CIED management for surgery, but it requires specialized provider training and strong support from the EPCS. Due to the complexity of CIED management, an ADS will likely only be feasible in high-volume settings.
From the Department of Anesthesiology and Pain Medicine (G.A.R., S.A.L., G.A.V.N., J.D., K.M.N.) and Division of Cardiology, Department of Medicine (L.W.L., J.E.P.), University of Washington, Seattle, Washington.
G Alec
GA
Rooke
Stefan A
SA
Lombaard
Gail A
GA
Van Norman
Jörg
J
Dziersk
Krishna M
KM
Natrajan
Lyle W
LW
Larson
Jeanne E
JE
Poole
D000776:Anesthesiology / Q000193:education / Q000379:methods*; D017147:Defibrillators, Implantable / Q000592:standards; D019468:Disease Management; D005260:Female; D006296:Health Services / Q000592:standards; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000592:standards; D019990:Perioperative Care / Q000379:methods* / Q000592:standards; D010820:Physicians / Q000592:standards; D012189:Retrospective Studies