To the Editor
We applaud Izrailtyan et al.1 and the accompanying editorial by Thompson and Mahajan2 for calling attention to the unique vulnerability of patients with cardiovascular implantable electronic devices and pacemakers1 and for highlighting a major knowledge gap for practicing anesthesiologists and those currently in training.
As perioperative physicians, we need better education and familiarity with the plethora of devices currently in use. The expert consensus guidelines from the American Society of Anesthesiologists and the Heart Rhythm Society are valuable for routine perioperative management but do little to address the management of acute malfunction.3,4 Thompson and Mahajan2 rightly call on us to become facile with these devices in concert with our electrophysiology and cardiology colleagues and encourage workshop attendance to stay current.
We in turn urge residency curriculum directors to incorporate more focused education on this burgeoning technology. Pacemakers and cardiovascular implantable electronic devices have become so ubiquitous that, in our opinion, no trainee should finish residency without a working knowledge of how to troubleshoot and manage these devices. Perhaps allowing for a dedicated “elective” in electrophysiology to facilitate resident education would allow our trainees to gain experience with these devices instead of grappling de novo with their challenges in clinical practice.
Anesthesiology programs are now following the new milestones for education as per the Accreditation Council for Graduate Medical Education, and it is revealing that these milestones make no mention of pacemakers further highlighting our concerns.
Addressing these issues will enhance patient safety and minimize trepidation and uncertainty when caring for these patients.
Sandeep Markan, MD, FCCP
Sloan Youngblood, MD
Crystal Wright, MD
Raja Rama Palvadi, MD
John Porter, MD
Department of Anesthesiology
Ben Taub General Hospital
Baylor College of Medicine
1. Izrailtyan I, Schiller RJ, Katz RI, Almasry IO. Case report: Perioperative pacemaker-mediated tachycardia in the patient with a dual chamber implantable cardioverter-defibrillator. Anesth Analg. 2013;116:307–10
2. Thompson A, Mahajan A. Perioperative management of cardiovascular implantable electronic devices: what every anesthesiologist needs to know. Anesth Analg. 2013;116:276–7
3. Crossley GH, Poole JE, Rozner MA, Asirvatham SJ, Cheng A, Chung MK, Ferguson TB Jr, Gallagher JD, Gold MR, Hoyt RH, Irefin S, Kusumoto FM, Moorman LP, Thompson A. The Heart Rhythm Society (HRS)/American Society of Anesthesiologists (ASA) Expert Consensus Statement on the perioperative management of patients with implantable defibrillators, pacemakers and arrhythmia monitors: facilities and patient management this document was developed as a joint project with the American Society of Anesthesiologists (ASA), and in collaboration with the American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Heart Rhythm. 2011;8:1114–54
4. American Society of Anesthesiologists.. Practice advisory for the perioperative management of patients with cardiac implantable electronic devices: pacemakers and implantable cardioverter-defibrillators: an updated report by the american society of anesthesiologists task force on perioperative management of patients with cardiac implantable electronic devices. Anesthesiology. 2011;114:247–61