How Should We Prepare the Patient With a Pacemaker/Implantable Cardioverter-Defibrillator?

Patients with a pacemaker or implantable cardioverter-defibrillator undergoing surgery present unique challenges and necessitate specific planning and procedures to provide safe and efficient perioperative care. The increasing number of patients with these devices and complexity of their perioperative management led to the publication of a Practice Advisory from the American Society of Anesthesiologists that was recently updated and an Expert Consensus Statement from the Heart Rhythm Society on this topic. General principles outlined in these documents include ensuring proper device function preoperatively, enacting a plan to mitigate the risk for electromagnetic interference intraoperatively, and ensuring appropriate postoperative device function and restoration of permanent parameters when necessary. This chapter reviews recommendations from both societies and offers additional insight for the perioperative care of these patients.