Cardiac Pacemaker in Pregnancy: How to Manage?

Despite the increasing use of permanent cardiac pacemakers in a younger patient population, there are little data related to pregnancy. Normal physiologic alterations of pregnancy need to be taken into account in the management of the pregnant woman with a pacemaker in place. Similarly, gestational events including the potential for surgical intervention require a basic knowledge of pacemaker technology and monitoring. We present a case of a patient with junctional escape rhythm and was implanted pacemaker during pregnancy. A 24 years old women referred from obstetric outpatient clinic with asymptomatic bradycardia and cryptogenic stroke 2 years earlier. ECG shows sinus arrest with junctional escape rhythm. After multi-disciplinary discussion, team decided to implant double chamber pacemaker implantation. The pacemaker setting is adjusted to prepare caesarean section at 39 weeks gestation with delivery of an aterm infant. The postoperative course was uneventful. Pre-pregnancy pacemaker settings were re-established after the postpartum period. The current literature on managing pregnant patients with pacemakers is quite limited. Such patients require a multidisciplinary approach to care. Electromagnetic Interference (EMI) should be noticed.

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Electromagnetic Compatibility Issues in Medical Devices

10.5772/intechopen.99694 ◽

2021 ◽

Author(s):

Ting-Wei Wang ◽

Ting-Tse Lin

Keyword(s):

Vagus Nerve ◽

Medical Devices ◽

Electromagnetic Interference ◽

Electromagnetic Compatibility ◽

Cardiac Pacemaker ◽

Medical Engineering ◽

Implantable Device ◽

Cardiac Pacemakers ◽

Implantable Medical Devices ◽

Vagus Nerve Stimulator

Electromagnetic compatibility (EMC) in biomedical applications is a significant issue related to the user’s life safety, especially in implantable medical devices. Cardiovascular diseases and neurodegenerative disorders are the main chronic disease worldwide that rely on implantable treatment devices such as cardiac pacemakers and vagus nerve stimulators. Both devices must have high EMC to avoid electromagnetic interference-induced health risks, even death during the treatment. Thus, it is important to understand how EMI can affect implantable devices and proactively protect devices from electromagnetic interference, providing reliable and safe implantable device therapy. To this end, this chapter comprehensively introduces the clinical issues and provides EMC requirements for the implantable device such as a cardiac pacemaker and vagus nerve stimulator. The significance of this chapter is to present the EMC important issues in medical engineering that can help to evolve reliable and secure implantable device development in the future.

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Medical rehabilitation approaches in patients with implanted pacemaker

Cardiosomatics ◽

10.26442/22217185.2020.1.200096 ◽

2020 ◽

Vol 11 (1) ◽

pp. 28-34

Author(s):

Bakhram G. Iskenderov ◽

Marina G. Ivanchukova ◽

Natalya V. Berenshtejn

Keyword(s):

Electromagnetic Interference ◽

Cardiac Pacemaker ◽

Cardiac Pacing ◽

Rehabilitation Program ◽

Social Adaptation ◽

Medical Rehabilitation ◽

Cardiac Pacemakers ◽

Treatment Regimens ◽

Rehabilitation Programs ◽

External Electromagnetic Fields

In the following review article, the principles and approaches of medical rehabilitation in patients with implanted pacemakers are discussed. It was shown that total benefit results from cooperation among medical, physical and psychological components of rehabilitation program and optimisation of the mode and parameters of cardiac pacing. Social adaptation of the patients with implantable pacemakers is of paramount importance and should be directed on avoidance of external electromagnetic fields and their influence on pacemaker functions, which in turn may be life-threatening for patient and the staff as well. The indications to diagnostic and treatment regimens including physiotherapeutic procedures should be clearly defined in order to avoid potential influence of electromagnetic interference on cardiac pacemaker. The well-structured medical rehabilitation programs need to be organised in order to improve quality of life and patients survival with regard to growing tendency of implantation of cardiac pacemakers.

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Tricuspid Valve Replacement in a Patient with a Leadless Cardiac Pacemaker: Current Guidelines and Recommendations for Perioperative Management

Case Reports in Anesthesiology ◽

10.1155/2021/5559830 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

River Hames ◽

J. W. Awori Hayanga ◽

Diane Schmidt-Krings ◽

Timothy Goldhardt ◽

John Bozek ◽

...

Keyword(s):

Valve Replacement ◽

Tricuspid Valve ◽

Electromagnetic Interference ◽

Perioperative Management ◽

Preoperative Evaluation ◽

Cardiac Pacemaker ◽

Tricuspid Valve Replacement ◽

Cardiac Pacemakers ◽

Monopolar Electrocautery ◽

Guidelines And Recommendations

Leadless cardiac pacemakers were developed to reduce complications associated with conventional transvenous pacemakers. While this technology is still relatively new, devices are increasingly being implanted. The perioperative management of patients with these devices has been underreported; we thus seek to add to the limited body of knowledge of perioperative management of patients with leadless cardiac pacemakers. An elderly female patient with a Micra VR transcatheter pacing system leadless cardiac pacemaker placed for tachycardia-bradycardia syndrome with intermittent complete heart block was scheduled for elective tricuspid valve replacement for severe tricuspid regurgitation. Pacemaker interrogation was performed several hours prior to the scheduled surgery based on the electrophysiologist’s availability; the device was kept in its programmed VVIR mode, and the base rate was increased from 60 to 80 beats per minute in anticipation of the upcoming surgery. Upon preoperative evaluation, the anesthesiologist asked that the electrophysiology team be placed on standby intraoperatively due to the concern that either oversensing in the setting of pacemaker dependence and/or undesirable tachycardia from rate-responsive pacing could occur. The surgeon used monopolar electrocautery for the duration of the cardiac surgery. Despite the patient having evidence of pacemaker dependence in the intensive care unit preoperatively, no electromagnetic interference leading to oversensing nor rate modulation was detected during intraoperative electrocardiographic and intraarterial invasive monitoring. Evidence-based guidelines regarding perioperative management specifically of leadless cardiac pacemakers do not exist. As these devices become more prevalent, further evaluation will be paramount to determine whether existing guidelines for perioperative management of conventional transvenous pacemakers apply.

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