Adverse device-related events associated with cardiac surgery in patients with implanted pacemakers, ICDs and cardiac resynchronization therapy devices

Recommendations and practice advisories on the perioperative management of patients with cardiac implantable electronic devices (CIED) focus mainly on non-cardiac interventions. However, data on adverse outcomes associated with CIED function in patients undergoing cardiac surgery are still limited.

We conducted a retrospective dual-center study at two hospitals in Germany, evaluating 200 consecutive patients with an implanted device who underwent cardiac surgery between 2008 and 2021. Adverse device-related events (ADE) associated with cardiac surgery were analyzed.

A total of 14 devices (7%) were identified with ADE of which three were diagnosed preoperatively and not related to the surgical procedure, while 11 (5.5%) were identified postoperatively. In 12 cases (86%) the ADE required surgical revision of the CIED system, in particular a lead revision or new lead implant in 9/12 patients (75%). There is no statistically significant difference regarding the total incidence of ADE according to the type of cardiac surgery: intracardiac surgery including valvular surgery with or without CABG (9 ADE out of 149 patients, 6%) versus CABG only (2 ADE out of 51, 4%), p=0,58.. Moreover no significant variations were observed in ADE occurrence depending on the type of device implanted, with 5% of the 148 patients having a pacemaker, 3.5% having an ICD, and 4.5% having a CRT device.

In patients undergoing cardiac surgery, peri-operative CIED-interrogation reveals a significant number of severe device-associated adverse events mainly related to the type of surgery. Pre- and postoperative device interrogation is therefore mandatory in this specific population. Further evaluation is warranted to form a solid basis for recommendations on appropriate perioperative management for device-carriers undergoing cardiac surgery.