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A Single-Centre algorithm on the safe use of diathermy devices in day-case surgery in patients with Cardiac Implantable Electronic Devices

Aasim Murtaza, Umran Sarwar
Bradford Teaching Hospitals Foundation Trust, Bradford, United Kingdom



  • Diathermy cautery is an essential tool for safe and effective operating in day-case surgery.
  • Diathermy is a known risk-factor which can interfere with some Cardiac Implantable Electronic Devices (CIEDs) causing morbidity and mortality.
  • Confusion persists amongst Health-Care Professionals on how to manage patients with CIEDs, causing unnecessary delays/cancellations.
  • This poster aims to clarify the recommended management to optimise safe day-case surgery.



  • A review of our Trusts peri/intra/post-operative policy for patients with CIEDs, including: Permanent Pacemakers (PPM), Implantable Cardioverter Defibrillators (ICD) and Implantable Loupe Recorders (ILR).


  • ICDs: Need to be programmed to ‘monitor only’ immediately pre-operatively - the patient is unprotected from ventricular arrhythmias and requires continuous cardiac monitoring intra-operatively and reprogramming immediately after the procedure.
  • PPMs: A ‘dependent’ PPM requires reprogramming before the operation. If ‘non-dependent’ no intervention is required.
  • If operating directly over the pacemaker site, asynchronous mode needs to be selected. This results in the device being unable to sense active change.
  • ILRs: No risk of interaction between diathermy and the device. No adjustments required.
  • The use bipolar diathermy is favoured over monopolar devices. Short bursts of the diathermy should be used as and when needed.


  • Understanding the process and rationale for patients who have CIEDs is key to ensuring patients are able to undergo operative procedures in a safe and effective manner which avoids unnecessary delays and cancellations on the day of operation.
  • We present a safe and effective algorithm that can be used by health-care professionals.