Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States.
Department of Anesthesia, Pain Management and Perioperative Medicine, Divisions of Cardiothoracic Anesthesia, Detroit, Michigan, United States.
Ann Card Anaesth. 2021 Oct-Dec;24(4):447-451. doi: 10.4103/aca.ACA_32_20.
Cardiac implantable electronic devices (CIED) are becoming more common for the management of underlying of cardiac dysrhythmias, and more patients with these devices are presenting for cardiac and noncardiac procedures.
We performed a retrospective, cohort, single-center study at a tertiary teaching medical center, gathering 151 patients with CIED undergoing elective and emergent surgeries for the time period between November 2013 and December 2016. We aimed to determine whether patients with CIED had the device interrogated before surgery as recommended by the Heart Rhythm Society (HRS)/American Society of Anesthesiologists (ASA) consensus, whether this lack of compliance led to delay in the holding area before surgery and determine the presence of intra- or postoperative cardiac events in these patients.
A total of 76% of patients had interrogation of the device before surgery. Emergent cases were not interrogated as much as elective cases preoperatively (43% vs. 18%, respectively; P < 0.05). In total, 6% of cases had a CIED-related average holding area delay time of 54 minutes. Patients without preoperative device interrogation had more perioperative cardiac events than those who had the device checked (25% vs. 8%, respectively; odds ratio [OR] 0.26; 95% CI, 0.09-0.7, P < 0.013).
Our findings suggest that preoperative interrogation of the device plays a significant role to minimize the incidence of perioperative cardiac adverse events. Institutional providers show a lack of compliance with HRS/ASA recommendations for preoperative CIED management. Further research is required to determine if improved compliance to recommendations will lead to enhanced outcomes.
心脏植入式电子设备（CIED）在心律失常的治疗中越来越常见，越来越多的患者需要进行心脏和非心脏手术。
我们在一家三级教学医疗中心进行了一项回顾性、队列、单中心研究，收集了 2013 年 11 月至 2016 年 12 月期间因心脏和非心脏手术需要进行选择性和紧急手术的 151 例 CIED 患者的资料。我们旨在确定 CIED 患者是否按照心脏节律协会（HRS）/美国麻醉医师协会（ASA）共识的建议在手术前对设备进行了检查，这种缺乏依从性是否导致手术前在等候区的延迟，并确定这些患者是否存在围手术期的心脏事件。
共有 76%的患者在手术前对设备进行了检查。紧急情况下的术前检查没有选择性手术那么多（分别为 43%和 18%；P<0.05）。总的来说，有 6%的病例因 CIED 相关的平均等候区延迟时间为 54 分钟。与设备检查的患者相比，未进行术前设备检查的患者围手术期心脏事件更多（分别为 25%和 8%；优势比[OR]0.26；95%置信区间，0.09-0.7，P<0.013）。
我们的研究结果表明，术前对设备进行检查对于减少围手术期心脏不良事件的发生具有重要作用。机构提供者对术前 CIED 管理的 HRS/ASA 建议缺乏依从性。需要进一步的研究来确定如果更好地遵守建议是否会带来更好的结果。
