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This is a literature review of the risks associated with bipolar and monopolar electrocautery in patients with a permanent pacemaker (PPM) or implantable cardioverter defibrillator (ICD). The authors found 12 publications which met their inclusion criteria, but within these there was only one level I evidence study and one level II evidence study. In the level I study, 80 subjects with ICDs were randomised to having the ICD turned off or suspended with a magnet during surgery, unless the surgery was within six inches of the ICD, in which case it was programmed off. Seventy-one patients were evaluated for electromagnetic interference (EMI) of the device, which was found in 12 of them. The level II study unfortunately did not differentiate between monopolar and bipolar cautery but found 34 episodes of EMI in 306 subjects. In another large study of over 14,000 patients who had bipolar cautery there were no adverse events. One paper found 25 instances of EMI with monopolar but none with bipolar. A total of five studies found EMI with monopolar, and three further studies reported EMI but didn’t differentiate between monopolar and bipolar. The authors suggest that EMI is improbable with bipolar, especially at a site distant from the device, and conclude that bipolar in facial surgery is safe to use without taking special precautions. Monopolar use within six inches of the device is a high risk, and less but not negligible on the face. This can be reduced by using short bursts at low power, and by positioning the dispersive electrode to minimise conduction through the cardiac device. ICDs should be reprogrammed off or suspended with a magnet if monopolar is used, and it may be advisable to switch to asynchronous mode for pacemaker dependent patients.

Implantable electronic cardiovascular device complications related to electrocautery during ophthalmology surgery: a systematic review.
Tauber J, Tingley JP, Barmettler A.
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James Hsuan

Aintree University Hospital, Liverpool, UK.

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