Can a patient with a pacemaker (permanent artificial cardiac pacemaker) and abnormal electrocardiogram (ECG) findings, including sinus rhythm, abnormal left axis deviation, and left anterior fascicular block, undergo cataract surgery safely?

Perioperative Management of a Pacemaker Patient Undergoing Cataract Surgery

Patients with permanent pacemakers can safely undergo cataract surgery if appropriate precautions are taken to manage potential electromagnetic interference from surgical equipment. 1

Preoperative Assessment

• Pacemaker Evaluation:

  • Identify pacemaker type and last device check
  • Determine if patient is pacemaker-dependent (crucial for management decisions)
  • Review ECG findings (sinus rhythm with left axis deviation and left anterior fascicular block)

• Risk Assessment:

  • Cataract surgery is low-risk non-cardiac surgery
  • The abnormal ECG findings (left anterior fascicular block) alone do not contraindicate surgery
  • Asymptomatic bifascicular block is not an indication for temporary pacing 1

Perioperative Management Plan

Electrocautery Considerations

• Use bipolar electrocautery whenever possible during cataract surgery to minimize electromagnetic interference 1
• If unipolar cautery is necessary:
  • Position the grounding plate away from the pacemaker generator
  • Keep the cautery device away from the pacemaker
  • Use only brief bursts at lowest possible amplitude
  • Ensure the current path does not cross the pacemaker or leads 1

Device Management

• For non-pacemaker dependent patients:

  • No reprogramming typically needed for cataract surgery
  • Have external defibrillator equipment readily available 1

• For pacemaker dependent patients:

  • Consider setting pacemaker to asynchronous (non-sensing) mode
  • This can be done by placing a magnet over the device during surgery 1
  • Alternatively, formal reprogramming by a device specialist

Intraoperative Monitoring

• Standard monitoring is sufficient (ECG, pulse oximetry, blood pressure)
• Continuous cardiac monitoring throughout the procedure 1
• Have external pacing/defibrillation equipment immediately available

Postoperative Care

• Pacemaker interrogation after surgery if:
  • Significant electromagnetic interference occurred
  • Patient is pacemaker-dependent
  • Underlying rhythm is unreliable 1

Important Considerations and Pitfalls

• Avoid misinterpreting the abnormal ECG findings as a contraindication to surgery

  • Left anterior fascicular block with or without first-degree AV block is not an indication for temporary pacing 1

• Electromagnetic interference risks:

  • Temporary inhibition of pacemaker output
  • Resetting to backup/safety mode
  • Inappropriate rate increases
  • Rarely, permanent device damage 1

• Communication is key:

  • Ensure the surgical team is aware of the pacemaker
  • Designate a responsible person for device management 1

Cataract surgery is generally a low-risk procedure with minimal electromagnetic interference when proper precautions are taken. The presence of a pacemaker and the noted ECG abnormalities should not prevent the patient from safely undergoing this necessary procedure.