Pacemakers

Pacemakers and ICDs Anaesthesia 2006

MHRA UK guidelines on PPM and diathermy published

Titanium casing* (modern) reduces external EMF interference so mobile phones etc now safe
Dual chamber PPMs better in heart failure
4th letter of code = R = rate modulation (ie DDDR, VVVIR * v common), normally via mov't sensor but also transthoracic impedance and incr resp rate sensor

Titanium case and built in interference monitor reduces EMF
Bipolar >> safer than unipolar; reprogramming probably not required if surgery not prolonged and away from PPM
Unipolar then plate away from PPM (if head and neck surgery then posterior surface of opposite shoulder)
Cardiac Monitors that use transthoracic impedance to measure RR combined with PPM that do the same thing tend to inappropriately 2x incr heart rate
External defibrillation: high risk of damage to PPM, and leads may burn myocardium: place pads (?AP) and ?10cm away from PPM
Magnets: variable response among PPMs but 99% of ICDs revert to bradycardia pacing only

Patients should always carry a PPM passport
No need for PPM check if one done within 3 months
Work out if the patient is PPM dependent (ie Hx of prev sy mptomatic bradycardia or AV node ablation)
Preop Ix: 12 lead ECG, rhythm strip, Potassium, CXR not routine
Bipolar only or minimal distant EMF then malfunction risk* minimal - do not reprogram; surgery should be OK but monitor and stop diathermy if problem
Unipolar / high EMF - PPM technician should reprogram (to monitor only) in theatre and remain present through-out;
Switch off thoracic impedance monitor
Emergency PPM system (internal, external should be available)
In an emergency attempt to stick to above as best as possible

Please contact Steve Harris if you have any questions.

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