Abstract
Purpose :
Implantable electronic cardiac devices (IECDs) such as cardiac pacemakers and implantable defibrillators are common life saving devices. Device-related complications can arise in patients undergoing surgical interventions with electrosurgical tools due to electromagnetic interference. Currently, ophthalmologists and oculofacial plastic surgeons rely on inconsistent protocols, which vary by institution, to guide their use of these devices in patients with IECDs. This systematic literature review assesses existing reports on electrocautery use during ocular and periocular surgery in patients with IECDs.
Methods :
This review was designed per Preferred Reporting Items for Systematic and Meta-Analysis guidelines. A literature search of published reports was conducted on all Evidence Based Medicine Reviews, Cochrane Databases and Registers, MEDLINE Ovid, Embase.com, Pubmed, and ClinicalTrials.gov. Search terms included “pacemaker” or “implantable cardioverter defibrillator” and “electrocautery” or “cautery”. Inclusion criteria were full text articles, discussing ocular, oculoplastic, or other facial (including dermatologic and head and neck) surgery. Exclusion criteria included non-English language or surgery focused on other parts of the body. Full-text manuscripts of identified articles were reviewed and relevant data were extracted. Data collected included author, publication year, study design, surgery type, electrosurgery type, IECD type, guidelines or findings.
Results :
Of 746 publications, twelve studies met inclusion criteria (Figure 1). A summary of these studies can be seen in Table 1. Different safety approaches were taken with pacemakers (such as applying magnets intraoperatively, converting to asynchronous mode, or performing no alterations) and implantable defibrillators (such as disabling prior to electrocautery or no intervention). Precautions such as preoperative device interrogation and limiting duration of current bursts were recommended more often with monopolar cautery.
Conclusions :
There is limited original research specifically focused on electrocautery choice during ocular and oculofacial plastic surgery in patients with IECDs. Existing studies suggest bipolar electrocautery and thermal cautery may be safer options compared to monopolar electrocautery in select patients with IECDs.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.