ICD
To be booked first on the list, with at least 3 weeks notice for pacing physiologists. Pacing physiologists do not provide an on call service.
Preop Assesment, Ascertain
Date of implant and reason,with underlying rhythm.
Type of ICD.
Battery longevity.
Date of last check and any concerns.
Programmed settings & magnet response. Physiologist to advise on reprogramming anti-tachycardia functions or use of magnet intraoperatively.
Intraoperative
Physiologist to reprogramme ICD preoperatively if required. Patient must remain on ecg monitoring if so.
Identify ICD at sign in and time out.
Transcutaneous pads and defibrillator in theatre, and magnet if appropriate.
If diathermy is required, bipolar is preferable. Monopolar in 5 second burst with pad below the umbillicus, away from PM if required.
Use lowest possible energy for diathermy.
If ICD functions inappropriately, halt electrocautery. Condsider magnet if appropriate.
Postoperative
Physiologist to reprogramme ICD to usual function.
Patient must remain on ECG monitoring until normal ICD function. If magnet was used, ecg monitoring can stop once magnet removed as normal function should resume.
If in doubt, discuss with physiologist or anaesthetist.
Emergency surgery
Surgery should ideally be delayed until above pre and intraoperative advice can be followed.
If unable to delay, proceed with defibrillator attached and the above intraoperative advice. Anesthetist to apply magnet if appropriate.
High voltage cardioversion and defibrillation could cause permanent damage, activation of back up modes or loss of capture post cardioversion. Risk is reduced by use of AP pads away from the device.