Document Detail


Electrocautery-induced ventricular tachycardia and fibrillation during device implantation and explantation.
MedLine Citation:
PMID:  17297178     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Electrocautery is commonly employed during surgical implantation and explantation of pacemakers and implantable cardioverter-defibrillators (ICDs). Four cases of electrocautery-induced ventricular tachyarrhythmias including ventricular tachycardia (VT) or ventricular fibrillation (VF) during device implantation or explantation are described. METHODS: The incidence of electrocautery-induced VT or VF at Winthrop University Hospital was analyzed over a 5-year period (November 2000 to March 2006). Specific devices, indications for device implantation or explantation, electrocautery configuration, and grounding patch placement were analyzed. RESULTS: Between November 2000 to March 2006, 4,698 devices were implanted and/or explanted at Winthrop University Hospital, of which 4 patients developed electrocautery-induced ventricular tachyarrhythmias. The patients had a mean age of 64+/- 16 years, and mean left ventricular ejection fraction of 34 +/- 9%. Three patients (75%) had severe coronary artery disease with prior myocardial infarction. Three patients (66%) had clinical hypertension. Three patients developed ventricular tachycardia during elective explantation of a malfunctioning device. One patient developed ventricular fibrillation during pacemaker implantation. Prior to each explant, the ICD was programmed off. Patients underwent explantation of a Medtronic Marquis model no. 7230CX ICD, Medtronic Marquis DR no.7274 and Guidant Ventak Prizm 2 model no. 1861. The mean age of explanted devices was 35 +/- 13 months. CONCLUSIONS: This study demonstrates a 0.09% incidence of provoked sustained ventricular tachycardia or ventricular fibrillation requiring external defibrillation during device implantation or explantation. This occurred despite programming off the ICD prior to device replacement, positioning the grounding pad far from the pulse generator and the use of bipolar electrocautery. We hypothesize that direct current energy is delivered to the pulse generator, lead and/or connector and then to the myocardium. Staff should be aware of electrocautery-induced VT or VF during device procedures and be prepared to promptly cardiovert and/or defibrillate VT/VF should this scenario occur.
Authors:
Ronald Lo; Alexandru Mitrache; Weilun Quan; Todd J Cohen
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of invasive cardiology     Volume:  19     ISSN:  1557-2501     ISO Abbreviation:  J Invasive Cardiol     Publication Date:  2007 Jan 
Date Detail:
Created Date:  2007-02-13     Completed Date:  2007-03-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8917477     Medline TA:  J Invasive Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  12-5     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Winthrop-University Hospital, 120 Mineola Blvd, Suite 500, Mineola, NY 11501, USA. lo@mad.scientist.com
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MeSH Terms
Descriptor/Qualifier:
Age Distribution
Aged
Aged, 80 and over
Defibrillators, Implantable*
Electrocardiography
Electrocoagulation / adverse effects*
Female
Follow-Up Studies
Humans
Incidence
Male
Middle Aged
Pacemaker, Artificial*
Probability
Retrospective Studies
Risk Assessment
Sex Distribution
Tachycardia, Ventricular / epidemiology,  etiology*
Ventricular Fibrillation / epidemiology,  etiology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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