Ten years experience of cardiac assessment in patients with cardiac device undergone oncology surgery

Ten years experience of cardiac assessment in patients with cardiac device undergone oncology surgery.

The increasing prevalence of oncological surgeries in patients with implanted cardiac devices—such as PMs and ICDs—is driven by an aging population and improved survival rates following oncology treatments. These devices pose unique challenges during oncological procedures, especially when the surgical site is in the upper thoracic region, near the device, or when monopolar electrosurgery is required. The absence of an on-site electrophysiologist can further complicate patient management and safety. To address these challenges, our hospital implemented a dedicated cardiac assessment protocol in 2014. Over ten years, we evaluated 690 patients, including 210 with combined ICD/PM systems, and 480 with PMs. Our protocol involves preoperative cardiac evaluation with verification of the most recent device interrogation (within 12 months for PMs and 6 months for ICDs). Coordination with the surgical team ensures proper planning regarding the proximity of the device to the surgical site and the type of electrosurgical equipment to be used. Key intraoperative management strategies include: Non-PM-dependent patients: A magnet is kept available in the operating room. Bipolar electrosurgery scissors are preferred; if monopolar electrosurgery is necessary, grounding plates are used and short bursts are recommended. PM-dependent patients: A magnet is placed over the device (for surgeries above the umbilical line), or the device is reprogrammed to asynchronous mode if a magnet is not available. Bipolar electrosurgery scissors are prioritized; monopolar electrosurgery requires grounding plates and short bursts are recommended. ICD/PM non-dependent patients: A magnet is placed over the ICD/PM to temporarily disable anti-tachycardia functions. Bipolar electrosurgery scissors are preferred; monopolar electrosurgery requires grounding plates and short bursts are recommended.

ICD/PM-dependent patients: For surgeries below the umbilical line, a magnet is used; for surgeries above this line, reprogramming to asynchronous mode and disabling anti-tachycardia functions are required. Bipolar electrosurgery scissors are prioritized; monopolar electrosurgery requires grounding plates and short bursts are recommended.Postoperatively, If reprogramming was performed preoperatively, devices are restored to their original settings.Additional assessments by a device engineer are required in specific cases:Device reprogramming prior to surgery.

ICD patients undergoing surgery above the umbilical line with monopolar electrosurgery.

Suspected device malfunction.PM located within 15 cm of the surgical site with use of monopolar electrosurgery. Serious intraoperative cardiac complications .Using this protocol, we achieved safe management of all patients undergoing oncological surgery without any recorded device-related complications.