With the technological advances and increasing life expectancy, anesthesiologists are more and more likely to encounter patients with cardiac implantable electronic devices (permanent pacemaker, implantable cardioverter-defibrillator ICD, implantable loop recorder) in their practice.
Examinees should know the basics of common CIEDs ( the permanent pacemaker PPM and the automated internal cardioverter-defibrillator AICD), device modes and operation, indications and pathophysiology of conditions necessitating insertion, the anaesthetic implications and peri-op management of a case with a PPM/ICD.
Questions on PPM and ICD are often asked in MCQs and form a frequently assessed area in viva sessions. Examiner may directly ask the management of a patient with a PPM insitu or make it a part of multiple comorbidities in the patient and lead you to CIEDs. Chest X-ray and ECG from a patient having PPM are in fact almost always asked from some of the candidates in Part-2 examination.
The chapter covers the basic understanding of device mechanics, common concerns surrounding the presence of CIED in the patient in the peri-op setting, the anaesthetic management of a case with PPM/AICD posted for non-cardiac surgery and some unique areas of concern in the patients with CIEDs.
In the end, we have included a section of the “Most commonly asked questions” in viva-sessions of EDAIC, FRCA and FCAI examinations.
FOR A DETAILED DISCUSSION ON THE ANAESTHETIC MANAGEMENT OF A CASE WITH PERMANENT PACEMAKER (OR AUTOMATED INTERNAL CARDIOVERTER-DEFIBRILLATOR) POSTED FOR NON-CARDIAC SURGERY, PLEASE DOWNLOAD THE CHAPTER “ANAESTHETIC IMPLICATIONS OF THE CARDIAC IMPLANTABLE ELECTRONIC DEVICES (CIED)”
