External and Implantable Pacemakers and Defibrillators

Approximately 250,000 pacemakers are implanted every year in the United States.26 As the population continues to age, the number is likely to increase; therefore, it is imperative for all physicians, especially anesthesiologists, to become familiar with implantable cardiac devices and the appropriate management of patients with these devices. Anesthesiologists must be comfortable evaluating and managing patients with pacemakers and/or defibrillators during the perioperative period, as more of this patient population present for noncardiac, elective surgery. This requires a strong understanding of the types of devices, indications, settings, and functionality. In addition, it is important to understand and anticipate possible interactions during surgery with surgical instruments, such as bi- and monopolar electrocautery. This review provides a brief overview of the history of implantable devices, presents the guidelines regarding indications for placement, discusses important management considerations, and concludes with recent advances and future directions. This review contains 1 figures, 5 tables, and 30 references.  Key Words: cardiac, defibrillator, electrophysiology, external, implantable, pacemaker, pacing, transcutaneous, transvenous