Reasons to check an Implanted Cardiac Device PreOp
What we need to know prior to checking the device.
Manufacture (Medtronic, Boston Scientific / Guidant, St. Jude, Biotronik)
Pacemakers
 Determine pacemaker settings and the magnet rate
 Determine if patient is dependent on the pacemaker.
 Device dependent patients (minimal to no heart rhythm when device is off)
o Surgical procedure is going to be close to the device
 will need to reprogram the device to a asynchronous mode so it does not
sense cautery (DOO, VOO, AOO)
 This requires us to return post op to reprogram to prior mode
o If surgical procedure is going to be remote to the device, or no cautery to be
used
 Use of a magnet should the patient develop bradycardia during the
procedure
 This makes the device asynchronous and will pace at a specific rate
 Patient has an underlying rhythm, not dependent on the device
o No changes need to be made to the device
o Use a magnet should the patient become bradycardic during surgery
 If the patient is not device dependent and has had a recent evaluation and/or the
anesthesiologist is comfortable with magnet application then there is no need for
device evaluation.
ICD (Implanted Cardioverter Defibrillator)
 Determine pacemaker/ ICD settings
 Determine if the patient is dependent on the pacemaker
 Pacemaker dependent patients, the magnet does not affect pacing in ICD’s
o If surgical procedure is going to be close to the device
 reprogram the device to a asynchronous mode so it does not sense
cautery
 This requires us to return post op to reprogram to prior mode
o Cannot program the ICD’s to asynchronous pacing mode without reprogramming
the Therapies to OFF
 Determine if the patient has had any dysrhythmias or therapies since last interrogation.
o If surgical procedure is going to be close to the device
 Reprogram the device to Inactivate the Therapies or Detection
1. This requires placement of Stat Pads to Anterior/Posterior chest
and monitoring by Nursing staff PreOp until patient is in the
OR.
2. This requires placement of Stat Pads to Anterior/Posterior chest
and monitoring by Nursing staff PostOp until patient therapies
are turned ON
 Patients have ICD’s for either real or potential lethal
dysrhythmias, if the therapies are inactivated it is the
responsibility of the staff to respond to dysrhythmias. This is a
Medical / Legal Issue.
o If surgical procedure is going to be remote to the device, or no cautery to be
used
 we recommend magnet placement during cautery
 Magnet use does not require us to return to reactivate the device
 for prolonged use of a magnet we can check the device to make sure
nothing was reset (this is very rare).
Contact EP by email when scheduled day to weeks before the surgery (Cindy Weston, Cathy
Kenny, Rick McLaughlin, Ann Czyz)
Contact EP day of procedure by calling Cindy Weston x87109, 303-266-1413, she will track down
someone to check the device. We are often doing procedures or seeing clinic patients.
 Please contact us when patient is admitted to PreOp, rather than waiting till the time of
the surgery, it gives us more time to get there. If we cannot come, Cindy will contact
the device company to come to check the device.
 Alternate numbers: Cathy Kenny 303-266-2601. Rick McLaughlin 303-266-1366.