Electrosurgery, pacemakers and ICDs: A survey of precautions and complications experienced by cutaneous surgeons

BACKGROUND. Minimal information is available in the literature regarding th e precautions implemented or complications experienced by cutaneous surgeon s when electrosurgery is used in patients with pacemakers or implantable ca rdioverter-defibrillators (ICDs), The literature pertinent to dermatologist s is primarily based on experiences of other surgical specialties and a gen erally recommended thorough perioperative evaluation. OBJECTIVE. TO determine what precautions are currently taken by cutaneous s urgeons in patients with pacemakers or ICDs, and what types of complication s have occurred due to electrosurgery in a dermatologic setting. METHODS. In the winter of 2000, a survey was mailed to 419 U.S.-based membe rs of the American College of Mohs Micrographic Surgery and Cutaneous Oncol ogy (ACMMSCO). RESULTS. A total of 166 (40%) surveys were returned. Routine precautions in cluded utilizing short bursts of less than 5 seconds (71%), use of minimal power (61%), and avoiding use around the pacemaker or ICD (57%). The types of interference reported were skipped beats (eight patients), reprogramming of a pacemaker (six patients), firing of an ICD (four patients), asystole (three patients), bradycardia (two patients), depleted battery life of a pa cemaker tone patient), and an unspecified tachyarrhythmia tone patient). Ov erall there was a low rate of complications (0.8 cases/100 years of surgica l practice), with no reported significant morbidity or mortality. Bipolar f orceps were utilized by 19% of respondents and were not associated with any incidences of interference. CONCLUSIONS. Significant interference to pacemakers or ICDs rarely results from office-based electrosurgery. No clear community practice standards reg arding precautions was evident from this survey. The use of bipolar forceps or true electrocautery are the better options when electrosurgey is requir ed. These two modalities may necessitate fewer perioperative precautions th an generally recommended, without compromising patient safety.