How is pacemaker interference by electrocautery prevented?
Electrocautery interference can be prevented by electively reprogramming the pacemaker to asynchronous ventricular pacing in the preoperative period. In an emer-gency, a magnet placed over the pacemaker generator will (at least temporarily) convert the pacemaker to an asyn-chronous pacing mode. It is important to recognize that differences exist between manufacturers and devices, such that not all pacemakers will convert with magnet applica-tion to a stable asynchronous mode for the duration of surgery. It is possible that the magnet response may have been turned off or other responses may have been programmed that do not protect from electrocautery interference.
The use of bipolar electrocautery, where the current enters and leaves the patient at the cauterization site through a forceps-like device, may also prevent electro-cautery interference. (In standard unipolar electrocautery, the current enters the patient through the cautery instru-ment tip and returns to the cautery machine through a return pad, which is often inaccurately referred to as a “grounding” pad.)