BJA Advance Access originally published online on May 28, 2004
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British Journal of Anaesthesia, 2004, Vol. 93, No. 1 95-104
© 2004 The Board of Management and Trustees of the British Journal of Anaesthesia
Pacemakers and defibrillators: anaesthetic implications
1 National Heart Lung Institute, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK. 2 Chelsea and Westminster Hospital, London, UK
*Corresponding author. Pacing and ICD Dept. E-mail: t.salukhe@imperial.ac.uk
Keywords: equipment, defibrillators; equipment, pacemakers
| The first 150 words of the full text of this article appear below. |
Cardiac pacemakers and implantable cardioverter-defibrillators have revolutionized the treatment of patients with cardiac arrhythmias. Since implantation of the first pacemaker in 1958, cardiac device therapy has seen a steady expansion. This is mainly attributable to phenomenal progress in device technology and software sophistication.
Recent data from landmark trials suggest that the indications for cardiac pacing and implantable defibrillators are set to expand further, to include, for example, heart failure, sleep disordered breathing and perhaps even routine defibrillator implantation in patients with myocardial infarction and poor ventricular function. This will inevitably result in more patients with cardiac devices being encountered by medical practitioners other than cardiologists.
This article reviews the basic principles of device nomenclature, function and physiology for pacemakers and defibrillators commonly encountered in surgical patients who may require anaesthesia.
Pacemaker and defibrillator mode codes
Pacemaker mode codes
The fundamental information required to understand normal pacemaker behaviour is the pacemaker code. The currently used North American Pacing and
Defibrillator mode codes
Basic physiology of cardiac pacing
Rate-adaptive/rate-modulated pacing
The importance of atrioventricular timing
Ventricular asynchrony and biventricular pacing
Electromagnetic interference
Asynchronous pacing
The refractory period
Interference behaviour
Mode resetting
Hospital sources of interference
Electrocautery
Diathermy
External cardioversion/defibrillators
Magnetic resonance imaging
Transcutaneous electrical nerve stimulation
Pacemaker programming and the use of magnets
The pacemaker clinic and device interrogation
Pacemaker magnets
Evaluation of the patient with an implanted cardiac device
Preoperative assessment
Intraoperative care
Postoperative care
Summary
Acknowledgement
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