ANAESTHETIC IMPLICATIONS OF THE CARDIAC IMPLANTABLE ELECTRONIC DEVICES (CIEDs)

With the technological advances and increasing life expectancy, anesthesiologists are more and more likely to encounter patients with cardiac implantable electronic devices (permanent pacemaker PPM, 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.