Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast Episode 311: Perioperative Management of AICDs and Pacemakers with Mark Nelson
Jun 29, 2025
Dr. Mark Nelson, Chair of the ASA Subcommittee on Cardiac Devices and an associate professor at VCU, shares his insights on managing AICDs and pacemakers in perioperative care. He introduces a practical management aid designed to bridge knowledge gaps for clinicians. The discussion covers the risks of electromagnetic interference, strategies for monitoring pacemaker-dependent patients, and advancements in remote monitoring. Listeners also hear about the latest digital stethoscope technology that enhances diagnostic capabilities.
AI Snips
Chapters
Transcript
Episode notes
EMI Risks Depend on Surgery Location
- Electrosurgery below the umbilicus generally poses minimal risk to implanted devices if ground pads are placed properly.
- Avoid underbody grounding pads in patients with devices as current may travel near the device, causing interference.
EMI Does Not Damage Devices
- Modern electrosurgical interference cannot damage pacemakers or ICDs physically.
- Rarely, devices can enter a power-on reset safety mode causing inefficient function but not permanent harm.
Use Magnets Carefully for Device Control
- Magnet placement disables ICD therapy and converts pacemakers to asynchronous pacing, but effects vary by manufacturer.
- Always monitor ECG to verify device response when applying a magnet and ensure magnet stays on the device to maintain effect.