Cardiac implantable electronic devices (CIEDs) such as pacemakers and implantable cardioverter-defibrillators (ICDs) are increasingly common, requiring healthcare providers to understand perioperative management. A comprehensive and organized approach is essential to guarantee patient safety and device functionality throughout the surgical episode.
Before elective procedures, teams must collaborate to gather information on device type, manufacturer details, model number, current settings, and functionality. The ASA recommends CIED interrogation within three to six months before scheduled surgery, ensuring that the device is functioning optimally and that any reprogramming needs are identified in advance.
Intraoperatively, continuous cardiac monitoring is essential, with special attention to electrosurgery units and the risk of electromagnetic interference with device sensing and therapy delivery. Anesthetic agents generally do not directly affect CIED function, but procedural factors such as surgical site proximity to the device and the use of electrocautery require careful planning.
Postoperatively, the ASA recommends continuous electrocardiographic and pulse oximetry monitoring, ensuring any deviations are promptly addressed. Device interrogation is specifically advised following emergency surgery, suspected permanent disabling of anti-tachyarrhythmia therapy, and following inappropriate shocks or documented electromagnetic interference exposure during the procedure.