To the Editor

As many readers of the APSF Newsletter may be aware, there are more and more people coming to surgery who have implanted Internal Cardiac Pacemaker Defibrillators or “ICPDs.” Since 1986, there have been approximately 25,000 ICPDs placed, predominately from three manufacturers: Guidant/CPI, Medtronic, and Ventritrix. There are currently four additional companies who have devices before the FDA for approval.

Should a patient come to surgery who has an ICPD in place, the ICPD needs to be deactivated since the use of electrocautery may cause the ICPD to discharge. If the surgery is elective, and if you know that the patient has an ICPD in place, it would be prudent to contact either the company representative or the cardiologist and have one of them deactivate the device. If time does not permit or if the surgery is urgent, the procedure for inactivating the ICPD is outlined below. Before you turn the ICPD off, you must first ascertain the reason for its original placement and turn it off only in the presence of electrocardiographic monitoring.

The steps for deactivating an ICPD are as follows:

1. Determine the make of the device. Hopefully the patient will have an ID card which will give you that information. The ID card will give you the manufacturer’s name, device type, and implanting physician’s name and number. If you know the name of the patient, you can call any of the companies’ 24-hour support line and they will tell you if that patient is in their database. All of the companies have the other companies’ 24-hour numbers. If the patient does not have his card, or if he is unresponsive, take an X-ray of the ICPD. All of the ICPDs have a unique X-ray silhouette which will give you the name or initials of the manufacturer.

2. Establish EKG monitoring.

3. For Guidant/CPI ICPDs: Place a donut magnet (only) over the device. You will hear a synchronous R wave beeping for 30 seconds. After 30 seconds the tone will become continuous. The continuous tone indicates that the ICPD is deactivated. If for some reason the tone does not become continuous at the end of 30 seconds, it means that the ICPD has been programmed to not allow deactivation. In this instance you must contact either the company representative or the cardiologist so that the ICPD can be reprogrammed to allow deactivation. At the end of the procedure reactivation is accomplished by reversing the procedure. Place the magnet over the ICPD and you will hear a continuous tone for 30 seconds. After 30 seconds the tone will convert to a synchronous R-wave beep. The programming should be verified after this procedure by either the CPI representative or the cardiologist.

4. For Metronic and Ventritrix ICPDs, placing a magnet over the device will inactivate the unit, and removing it will reactivate it. If necessary you can tape the magnet over the ICPD for the duration of the procedure. Again at the end of the procedure you will need to contact either the company representative or the cardiologist to verify the programming of the unit.

5. The 24-hour numbers for the manufacturers are:

Guidant/CPI: 1-800-227-3422

Medtronic: 1-800-PCDINFO

Ventritrix: 1-800-733-3455

Thomas A. Webster, M.D. Old Pueblo Anesthesia Tucson, AZ