Assessment and management of patients with pacemakers and implantable cardioverter defibrillators

OBJECTIVETo review the design and function of pacemakers and implantable cardioverter defibrillators with particular attention to those aspects that are of clinical relevance to perioperative and critical care physicians. MAIN POINTSPacemakers and implantable cardioverter defibrillators are complex devices that interact with cardiac function in ways that can significantly influence hemodynamics. A basic appreciation of device technology is essential to understanding both the normal patterns of pacemaker and implantable cardioverter defibrillator usage and the ways in which iatrogenic influences may result in adverse outcomes. The most important concern for pacemaker patients who enter the hospital is exposure to electromagnetic interference. Exposure is mainly from surgical cautery, but other sources are also present. With awareness of these concerns and an understanding of how to prevent adverse interactions, it is possible to safely care for these patients in the critical care setting. Despite recommended precautions, undesirable outcomes may occur and the clinician must be prepared to intervene in an appropriate manner to prevent patient injury.