From the Guidelines
Bipolar cautery can potentially affect an Automatic Implantable Cardioverter Defibrillator (AICD), but the risk is lower compared to monopolar cautery, and with proper precautions, the risk can be minimized. When using bipolar cautery near a patient with an AICD, take the following precautions:
- Consult with the patient's cardiologist before the procedure.
- Have the AICD reprogrammed to "monitor only" mode if possible, as recommended by the 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery 1.
- Keep the cautery current path as far from the AICD as possible to reduce the risk of electromagnetic interference.
- Use short, intermittent bursts of cautery rather than prolonged application to minimize the risk of interference.
- Have emergency cardiac equipment readily available in case of an adverse event.
- Monitor the patient closely during and after the procedure to quickly identify and respond to any potential issues.
Bipolar cautery can interfere with AICD function by inducing electromagnetic interference, which may cause the device to misinterpret the electrical signals as cardiac arrhythmias, potentially leading to inappropriate shocks or temporary inhibition of pacing 1. However, the risk is lower with bipolar cautery compared to monopolar, as the current is more localized. It is essential to follow the recommendations outlined in the 2014 ACC/AHA guideline and to communicate effectively with the patient's cardiologist and the surgical team to ensure the best possible outcome for the patient 1.
The use of bipolar electrocautery or harmonic scalpel can minimize the risk of interaction with the CIED, unless energy is applied directly to the CIED generator or leads in the operative field 1. In advance of elective surgical procedures, a perioperative CIED prescription should be developed by the clinician or team that follows the patient in the outpatient setting and communicated to the surgical/procedure team 1.
From the Research
Effects of Bipolar Cautery on AICD
- The study 2 found that bipolar cautery did not induce electromagnetic interference (EI-EMI) in patients with implantable cardioverter-defibrillators (ICDs).
- In contrast, monopolar cautery resulted in noise detection in 11 out of 92 procedures, highlighting the potential risks of using monopolar cautery in patients with ICDs.
- The study 2 also noted that EI-EMI does not occur when bipolar cautery or monopolar cautery is used below the hips with the dispersive ground pad applied to the lower extremities.
Safety of Bipolar Cautery
- The study 3 demonstrated the feasibility and safety of using bipolar radiofrequency track cautery during percutaneous image-guided abdominal biopsy procedures in at-risk patients.
- Another study 4 found that bipolar cautery tonsillectomy using different energy doses resulted in minimal postoperative bleeding rates and pain scores.
- The use of bipolar forceps is recommended when using electrosurgery in patients with implantable electronic cardiac devices (IECDs), as they are more resistant to interference 5.
Comparison with Monopolar Cautery
- The study 6 reported a case where monopolar cautery was used in a patient with a vagal nerve stimulator during neuromuscular scoliosis surgery, highlighting the potential risks and benefits of using monopolar cautery in certain situations.
- In general, bipolar cautery is considered a safer option than monopolar cautery when used in patients with implantable electronic cardiac devices, due to its reduced risk of electromagnetic interference 2, 5.