A 74-year-old man with an implantable cardioverter-defibrillator (ICD) for ischaemic cardiomyopathy is posted for open cholecystectomy using monopolar diathermy. What is the most appropriate preoperative device management?

• A Interrogate and reprogram the device to disable antitachycardia therapies, with external defibrillation pads applied ✓
• B No action needed; ICDs are unaffected by electrosurgical interference
• C Place a magnet over the device throughout surgery and rely on it alone
• D Switch the diathermy from monopolar to bipolar mode and take no further steps

Explanation

Monopolar cautery generates electromagnetic interference that can be misread as ventricular fibrillation, triggering inappropriate shocks, or can inhibit pacing. Best practice is formal interrogation with deactivation of tachyarrhythmia detection and therapy plus continuous ECG and standby external pads. B magnet suspends shock therapy in most ICDs but does not alter bradycardia pacing behaviour predictably and should never be the sole plan. Bipolar diathermy reduces but does not eliminate interference, so it supplements, not replaces, reprogramming.

Reference: Miller's Anesthesia, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.