Top Things to Know: Periprocedural Management and Multidisciplinary Care Pathways for Patients with Cardiac Implantable Electronic Devices
Published: July 10, 2024
Prepared by Ashley L. Wagner PA-C, Associate Science and Medicine Advisor
- There is a rapid rise in technological advancements in cardiac implantable electronic devices (CIEDs) such as pacemakers, implantable cardioverter-defibrillators, and loop recorders, coupled with a rise in the number of patients with these devices.
- Understanding and managing patients with CIEDs is of utmost importance as interference with device function during procedures may result in hemodynamic disturbances or arrhythmias.
- This scientific statement provides a framework for the periprocedural management of patients with these devices, encompassing the planning phase, procedure, and subsequent care coordinated with the primary device managing clinic.
- Optimal perioperative management of a patient with a CIED focuses on patient-centered care that includes preprocedural assessment and effective and timely communication with the procedural team.
- Communication with the device team about the upcoming procedure or about device changes after the procedure can facilitate a plan and ensure patient safety and safe continuity of care.
- The preprocedural assessment includes evaluation of patient-specific factors, such as pacemaker dependency and CIED location, as well as device-specific features.
- Patients with defibrillators, leadless pacemakers, or those who are pacemaker-dependent require special considerations during procedures.
- Magnets may be useful during procedures to influence the function of a CIED in certain emergent scenarios.
- Following the procedure, it is necessary to ensure that the device is returned to its prior setting.
- Multidisciplinary care pathways before and after the procedure are essential for managing devices in patients to ensure patient safety and appropriate device function.
Citation
Wan EY, Rogers AJ, Lavelle M, Marcus M, Stone SA, Ottoboni L, Srivatsa U, Leal MA, Russo AM, Jackson LR 2nd, Crossley GH; on behalf of the American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Surgery and Anesthesia; and Council on Peripheral Vascular Disease. Periprocedural management and multidisciplinarycare pathways for patients with cardiac implantable electronic devices: a scientific statement from theAmerican Heart Association. Circulation. Published online July 10, 2024. doi: 10.1161/CIR.0000000000001264