How is
the patient with an AICD managed in the perioperative period?
There are two major concerns with the patient
present-ing for surgery who has an AICD implanted. First, the reason why the
patient had the device implanted should be thoroughly evaluated and anesthetic
management planned accordingly. For example, patients with severe left
ventric-ular dysfunction require more intensive monitoring and altered
anesthetic technique. Second, factors that may interfere with proper function
of the device must be antic-ipated and measures taken to prevent malfunction.
In the perioperative period, the most likely source of interference with AICD function
stems from high-frequency electro-magnetic signals caused by surgical
electrocautery. The AICD software may interpret these signals as ventricular
fibrillation or tachycardia and the AICD device may respond with inappropriate
shock delivery or antitachy-cardia pacing. This, in turn, could potentially
cause severe dysrhythmias. Therefore, the current recommendation for patients
with an AICD undergoing elective surgery is to reprogram the device prior to
surgery in order to deacti-vate dysrhythmia-sensing and defibrillator
functions, and to set the pacemaker function to an asynchronous mode if
possible. Preoperative assessment should include determining the details of the
manufacturer, the model, the programmed settings, and when the device was last checked
for proper function and battery charge. Once the device is deactivated, an
external defibrillator must be readily available at any time and external
defibrillator pads may be placed on the patient. In emergency cases only, a
magnet can be placed over the device to deactivate the dysrhythmia detection
and defibrillator functions of the AICD. Various models and manufacturers might
differ in details as to how the pacing mode or the defibrillator mode is
altered when a magnet is placed over the device or after the magnet has been
removed. After any procedure, elective or emergency, the proper function of the
AICD device has to be evaluated by qualified personnel.
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