AICD deactivation

[pd4emergence]

I had a elective case today in a lady with an AICD (AICD only no pacing function). I had a long discussion with the AICD rep (St. Jude) who was deactivating it. She basically said that placing a magnet over the things was as good as them turning them off. I had a similiar discussion with the MedTronic rep not too long ago. (Medtronic and St. Jude are the two AICD's I see the most). I am still uncomfortable not having them deactivated preop just because that is what the I have always done. I was wondering if anybody does anything different.

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[militarymd]

I just stick a magnet on them...and have the reps interrogate them in the PACU.

 

[urgewrx]

http://www.asahq.org/Newsletters/2006/01-06/rozner01_06.html



January 2006
Volume 70

Number 1​

Informing the Misinformed About ICDs Marc A. Rozner, Ph.D., M.D.

any anesthesiologists, surgeons, and cardiologists wrongly believe that all implantable cardioverter-defibrillators (ICDs) work, although most devices actually perform as designed and programmed. Most physicians also believe that a magnet will always suspend tachy therapy (such as shock).
///////
Some ICDs can be programmed to ignore magnet placement (St. Jude Medical, Syl Mar, California; Guidant Medical, Indianapolis, Indiana; Angeion Corporation, St. Paul, Minnesota). When a magnet mode is present and enabled, often there is no good way to confirm appropriate magnet placement, since only ICDs from Guidant provide unambiguous feedback of correct magnet placement and, therefore, suspension of tachy therapies. It is interesting to note that some pacemakers also can be programmed to ignore magnet placement, yet many physicians wrongly believe that all pacemakers convert to some continuous, asynchronous pacing behavior with magnet placement.
//////
Guidant issued a notice regarding malfunction of the magnetic reed switch in a number of their ICDs used in patients with severe cardiomyopathies, and Guidant recommends that magnet function be permanently disabled by programming in these ICDs.

 

[urgewrx]

She basically said that placing a magnet over the things was as good as them turning them off.

They just don't want to be called.

 

[BLADEMDA]

http://www.asahq.org/Newsletters/2006/01-06/rozner01_06.html



January 2006

Volume 70

Number 1​

Informing the Misinformed About ICDs Marc A. Rozner, Ph.D., M.D.

any anesthesiologists, surgeons, and cardiologists wrongly believe that all implantable cardioverter-defibrillators (ICDs) work, although most devices actually perform as designed and programmed. Most physicians also believe that a magnet will always suspend tachy therapy (such as shock).

//////
Guidant issued a notice regarding malfunction of the magnetic reed switch in a number of their ICDs used in patients with severe cardiomyopathies, and Guidant recommends that magnet function be permanently disabled by programming in these ICDs.

I used this ASA newsletter to inform my colleagues, Dept. of Cardiology and the Head of Nursing/O.R. supervisor about my concerns. Here was my answer based on the Dept.of cardiology.

St. Jude and Medtronic (Medtronic has more than 50% of the market) would get the magent. If the Anesthesiologist INSISTED a rep. would check the AICD postoperatively within about 12 hours.

Guidant devices were another story. The Guidant rep. could be requested to turn on and off the AICD in a timely manner. The Guidant rep. could also verify that the particular AICD in question was NOT at risk of malfunction by the magnet. Fortunately, the guidant rep. has been very accomodating and the number of Guidant AICD's is low.

Blade

 

[urgewrx]

A lot of my pts don't even know if they have a pacer or an ICD. Do you think I'm going to trust them when they say "yeah, Medtronic sounds about right"
Somehow they all manage to lose their icd card.

Somebody made a lot of money with that ICD. I expect them to check every single one of them pre op.
​

 

[BLADEMDA]

A lot of my pts don't even know if they have a pacer or an ICD. Do you think I'm going to trust them when they say "yeah, Medtronic sounds about right"

Somehow they all manage to lose their icd card.​

Somebody made a lot of money with that ICD. I expect them to check every single one of them pre op.​

I agree with you. But, the reps. didn't like my constant calling and making them show up in the holding area and PACU. They complained to all the Cardiologists about one pain in the ass Anesthesiologist who INSISTED EVERY device be checked. I asked the Medtronic Rep. to get me a document from their LEGAL department about the whole magnet thing. I wanted Medtronic to state in writing that is was acceptable to place a magnet and then remove it later. Then, the AICD would function perfectly like before.
I never got anything in writing. Instead, I got a picture from Medtronic how to activate and deactivate the AICD using a magnet. So, I took the issue to the Dept. of Cardiology. A compromise was reached and the Cardiologists "felt comfortable" with the post-op rule stated above. Needless to say I always insist that the device get checked by the Rep.

As for knowing what brand of AICD that is essential. How else do you know which Rep. to call? Plus, Guidant has some garbage devices still in patients so the BRAND matters.

Blade

 

[Noyac]

A lot of my pts don't even know if they have a pacer or an ICD. Do you think I'm going to trust them when they say "yeah, Medtronic sounds about right"
Somehow they all manage to lose their icd card.

Somebody made a lot of money with that ICD. I expect them to check every single one of them pre op.
​

First, it is your surgeons duty to know what device the pt has b/4 bringing them to the OR. If they throw an AICD on you first thing in the morning without your knowledge, rip them a new one and the case doesn't go on time.

So even if the pt doesn't have his card the surgeon should know the make and model from their office visit.

Now as for the comment, "somebody made a lot of money with that ICD" well in Louisiana were I saw a sh*tload of them, those reps are busy, very busy. If you want them to respond to your every becking call then you had better give them warning. If they are not there on time then you let the surgeon know that, had he worked his pt up appropriately this would not have happened and his case would be on time. Then tell him, "I'll be doing your partners case and then I'll get back to you."

 

[pd4emergence]

Thanks for the info. I always get them checked post op. We have also tried to get the Medtronic and St. Jude (I have not run into any guidant AICD's) people to write us a letter saying the same...but no dice. Most of the folks in my group make the reps come and will not use the magnet for pt's with AICD's (elective cases of course). I have used the magnet on occasion when the one rep we have for our area could not get here. Thanks again.

 

[BLADEMDA]

Thanks for the info. I always get them checked post op. We have also tried to get the Medtronic and St. Jude (I have not run into any guidant AICD's) people to write us a letter saying the same...but no dice. Most of the folks in my group make the reps come and will not use the magnet for pt's with AICD's (elective cases of course). I have used the magnet on occasion when the one rep we have for our area could not get here. Thanks again.

Used the magnet hundreds of times- no problems so far. I am more concerned about the function of the device AFTER they leave my care.

Blade

 

[rmh149]

We call the cath lab staff or the pacemaker nurse to come down and deactivate the AICD.

If the case is an emergency and the above staff is not available, we then call the reps. So far, the cath lab staff have always been available....someone is on call 24 hours/day.

If that fails, they get a magnet.... put the bovie pad as far away from the AICD as possible. And ask the surgeon to keep the electrocautery to as short of bursts as possible.

 

[Noyac]

We call the cath lab staff or the pacemaker nurse to come down and deactivate the AICD.

If the case is an emergency and the above staff is not available, we then call the reps. So far, the cath lab staff have always been available....someone is on call 24 hours/day.

If that fails, they get a magnet.... put the bovie pad as far away from the AICD as possible. And ask the surgeon to keep the electrocautery to as short of bursts as possible.

Genius!






Are you kidding me? This is as basic as it gets.

 

[rmh149]

Genius!

Are you kidding me? This is as basic as it gets.

Basic response for a basic topic. How complicated did you want to make managing an AICD?

You must be in an academic setting....just a guess.

 

[Intubate]

There are practice guidelines for this on the ASA website. Unfortunately they are ridiculous. I have AICDs disabled if there's going to be possibility for interference (bovie). I think the recommendations say everyone with a pacer (not just an AICD) needs an interrogation. Whatever.

 

[jetproppilot]

Basic response for a basic topic. How complicated did you want to make managing an AICD?

You must be in an academic setting....just a guess.

Jet senses movement in the structure twelve hundred yards to the south. Scanning the building with binoculars, he spots him....second floor, most-eastern window. He cracks the window, leans back in the chair, and aims the SEVEN SIX TWO MILLIMETER towards the house.....

"Go ahead, Dude. Make another move," Jet mutters as he sizes up the figure in his scope.

 

[Planktonmd]

Jet senses movement in the structure twelve hundred yards to the south. Scanning the building with binoculars, he spots him....second floor, most-eastern window. He cracks the window, leans back in the chair, and aims the SEVEN SIX TWO MILLIMETER towards the house.....

"Go ahead, Dude. Make another move," Jet mutters as he sizes up the figure in his scope.

And he will make another move because he just can't help it !

 

[SouthSideSteve]

You must be in an academic setting....just a guess.

jesus christ dude, you got balls throwing that around. rofl.

 

[urgewrx]

If the case is an emergency and the above staff is not available, we then call the reps.

In case of emergency I rip it out with my teeth.

 

[urgewrx]

First, it is your surgeons duty to know what device the pt has b/4 bringing them to the OR.

Our surgeons: "What? He has a pacemaker/ICD? Oh he must be sick!