title: ICD-ON Registry for Perioperative Management of CIEDs: Most Require No Change.
abstract: BACKGROUND
  There is significant variability in the perioperative management of patients with cardiac implanted electronic devices (CIEDs) undergoing procedures requiring electrosurgery.
  
  
  METHODS
  We performed a multicenter registry from February 2014 to August 2015 at three suburban Chicago hospitals. Patients with transvenous CIEDs undergoing procedures requiring electrosurgery were assigned to one of three groups: (1) reprogram, (2) magnet, or (3) no change. Subjects with implantable cardioverter defibrillators (ICDs) or those pacemaker dependent having surgical procedures within 6 inches of their CIED were assigned to the reprogram group, whereby ICD therapies were programmed off with asynchronous pacing if pacemaker dependent. Subjects with ICDs ≥ 6 inches from their surgical site but above the iliac crest were assigned to the magnet group. All others were in the no change group. We evaluated electromagnetic interference (EMI) and postoperative device reset based on surgical location.
  
  
  RESULTS
  All patients (n = 331) had pectoral CIEDs with mean age 73 years, 65% male, ejection fraction 56% for pacemaker subjects, 35% for ICD subjects with 22% pacemaker dependent. Assignments were n = 52 (16%) reprogram group, n = 51 (15%) magnet group, and n = 228 (69%) no change. There was EMI in 45% of thoracic cases, 35% of head/neck, 15% of upper extremity, and 3% of abdominal cases above iliac crest. There was no EMI in procedures below the iliac crest. There were no inappropriate therapies or device reset.
  
  
  CONCLUSIONS
  Results of the ICD-ON protocol demonstrate safe and efficient management of patients with CIEDs based on electrosurgery location, with 69% requiring no reprogramming or magnet application.
authors.affiliation: Edward Hospital, Naperville, Illinois.
authors.forename: Janet
authors.initials: J
authors.lastname: Gifford
authors.affiliation: School of Nursing, DePaul University, Chicago, Illinois.
authors.forename: Karen
authors.initials: K
authors.lastname: Larimer
authors.affiliation: Edward Hospital, Naperville, Illinois.
authors.forename: Celia
authors.initials: C
authors.lastname: Thomas
authors.affiliation: Advocate Good Samaritan Hospital, Downers Grove, Illinois.
authors.forename: Patricia
authors.initials: P
authors.lastname: May
mesh_terms: D000368:Aged; D016477:Artifacts; D002641:Chicago / Q000453:epidemiology; D000075202:Contraindications; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D004598:Electrosurgery / Q000706:statistics & numerical data*; D004868:Equipment Failure / Q000706:statistics & numerical data*; D019544:Equipment Failure Analysis / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D061214:Patient Safety; D019990:Perioperative Care / Q000706:statistics & numerical data; D012042:Registries; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: ICD, pacing, magnet, electrosurgery, EMI; defibrillation