Electrosurgery and implantable electronic devices: review and implications for office-based procedures.

The number of patients with implantable electronic devices (IEDs) is growing as indications for a myriad of cardiac and neurological disorders that cannot be managed using medication alone expand. These devices include gastric and cardiac pacemakers, implantable cardioverter defibrillators, cochlear implants, and a range of stimulators of the deep brain, vagal nerve, sacral nerve, phrenic nerve, spinal cord, and bone. Encountering patients with an IED who present for office-based procedures is becoming increasingly common. Electromagnetic interference (EMI) during routine procedures has been reported to be associated with inappropriate functioning of IEDs. Adverse effects of performing electrosurgery on patients with IEDs pose a patient safety risk. Medical and manufacturer reports have primarily focused on larger electrosurgical equipment used in hospitals and their effect on IEDs. Our purpose was to provide a clinical review of commonly encountered IEDs, their clinical indications, potential interference with officebased electrosurgical equipment, and recommendations to prevent complications and injury.