Department of Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, USA.
Anesth Analg. 2011 Jun;112(6):1358-61. doi: 10.1213/ANE.0b013e3182172a18. Epub 2011 May 5.
Electromagnetic interference (EMI) induced by electrocautery during surgery in patients with cardiac pacemakers or implanted cardioverter-defibrillators (ICDs) may inhibit pacing and cause inappropriate tachyarrhythmia oversensing. In particular, susceptibility to EMI may be enhanced in ICDs by frequently used wide interelectrode sensing (i.e., integrated bipolar sensing). Consequently, ICD function is usually disabled preoperatively and restored later by noninvasive programming. Because sensing by closely spaced electrodes (i.e., true bipolar) may be less susceptible to EMI, preoperative programming to a true bipolar mode may minimize the need for perioperative programming while preserving device function.
Our study population consisted of 23 consecutive patients either receiving a new ICD or undergoing ICD pulse generator change. In each patient, electrocautery-induced EMI was initiated with the ICD in the closely spaced sensing configuration and again during widely spaced sensing.
In comparing the 2 sensing modes, right ventricular electrogram amplitude was significantly greater and EMI noise amplitude tended to be greater with widely spaced bipolar sensing. Furthermore, widely spaced bipolar sensing was associated with ICD pacing inhibition in 22 of 23 patients and incorrect "ventricular fibrillation" detection in 17 of 23 patients. Conversely, closely spaced bipolar sensing was not accompanied by either pacing inhibition or incorrect ventricular fibrillation sensing.
Closely spaced bipolar sensing (i.e., true bipolar) appropriately rejects electrocautery-induced EMI. Programming implanted devices to closely spaced bipolar sensing may minimize the need for perioperative reprogramming while preserving intraoperative device operation.
在心脏起搏器或植入式心脏复律除颤器（ICD）患者手术中，电外科产生的电磁干扰（EMI）可能会抑制起搏并导致不适当的心动过速感知。特别是，ICD 中常用的宽电极感知（即集成双极感知）可能会增强对 EMI 的敏感性。因此，通常在术前禁用 ICD 功能，然后通过非侵入性编程进行恢复。由于靠近电极的感知（即真正的双极）可能对 EMI 的敏感性较低，因此术前编程为真正的双极模式可能会最大限度地减少围手术期编程的需求，同时保留设备功能。
我们的研究对象包括 23 例连续接受新 ICD 或 ICD 脉冲发生器更换的患者。在每位患者中，使用 ICD 在紧密间隔的感知配置下和在广泛间隔的感知下启动电外科引起的 EMI。
在比较这两种感知模式时，与广泛间隔的双极感知相比，右心室电图幅度显著更大，EMI 噪声幅度也更大。此外，在 23 例患者中，广泛间隔的双极感知与 22 例患者的 ICD 起搏抑制和 17 例患者的错误“心室颤动”检测相关。相反，紧密间隔的双极感知没有伴随起搏抑制或错误的心室颤动感知。
紧密间隔的双极感知（即真正的双极）适当拒绝电外科引起的 EMI。将植入设备编程为紧密间隔的双极感知可能会最大限度地减少围手术期重新编程的需求，同时保留术中设备的操作。
