Anesthetic Management of Patients with Cardiovascular Implantable Electronic Devices

Abstract

C IED were first introduced in 1958, then (ICDs) followed in 1980. Since then, more than 2000 models of PMs. There has been a significant change not only in pulse generators and leads but also in the indications for pacing, pacing modalities, implantation techniques and follow up of patients with implanted pacing devices (CIED) include the PM, ICD, CRT and CCM. Indications of permanent PMs include: sick sinus syndrome, Second and third degree AV block, LBBB, RBBB, congenital long Q-T syndrome, cardiomyopathy and decompensated HF. Automatic implantable cardioverter-defibrillators are devices resembling PMs and have the ability to treat dangerously tachydysrrhythmias of the heart, either via pacing or defibrillation. Many of these devices can also treat bradydysrrhythmias the same way as PM. CRT improves symptoms, quality of life (QoL), exercise tolerance, and reduces hospitalizations in patients with advanced HF and prolonged electrical activation (i.e. increased QRS duration). CCM signals are non-excitatory signals delivered to the LV 30 ms after QRS onset so enhances the strength of LV contraction. CCM effects are independent of QRS duration and additive to those of CRT so decreases LV volumes and increases EF. CCM signals acutely affect calcium handling but also expression of proteins and genes involved in Ca handling so improves exercise tolerance and quality of life.