Pacemakers Are Not a Contraindication to Biopsy Procedures
Patients with permanent pacemakers can safely undergo biopsy procedures without contraindication, provided appropriate precautions are taken regarding electrocautery use. 1
Key Safety Considerations
Electrocautery Management During Biopsy
The primary concern with pacemakers during biopsy procedures relates to electromagnetic interference from electrocautery, not the biopsy itself. 1
Specific precautions to minimize risk:
Use bipolar electrocautery systems preferentially over unipolar systems, as they generate significantly less electromagnetic interference and are far less hazardous 1
Apply electrocautery in short bursts only, keeping power output to the minimum required 1
Position the electrocautery ground plate appropriately to complete the electrical circuit away from the pacemaker 1
Keep the electrocautery device physically distant from the pacemaker generator 1
Pacemaker-Dependent Patients
For patients who are pacemaker-dependent (meaning they have no reliable underlying cardiac rhythm):
Reprogram the device to asynchronous mode (VOO or DOO) before the procedure to prevent inappropriate inhibition 1
Alternatively, place a magnet over the pacemaker during electrocautery use to activate asynchronous pacing 1
Ensure continuous ECG and pulse monitoring throughout the procedure, as electrocautery can interfere with ECG interpretation 1
Non-Pacemaker-Dependent Patients
For patients with adequate underlying rhythm who are not pacemaker-dependent:
Device interrogation may not be necessary if electrocautery will be remote from the device, used in brief bursts, and ECG/pulse oximetry monitoring is available 1
External pacing capability should be immediately available in case of unexpected pacemaker inhibition 1
Post-Procedure Management
Interrogate the pacemaker after the procedure to ensure appropriate programming and verify sensing/pacing thresholds remain intact 1
This is particularly important for pacemaker-dependent patients and when significant electrocautery was used 1
Common Pitfalls to Avoid
Do not confuse biopsy contraindications with MRI contraindications. While MRI remains contraindicated or requires extensive precautions with pacemakers 1, standard biopsy procedures pose no such absolute restriction. 1
Do not assume all procedures require device reprogramming. The extent of evaluation depends on pacemaker dependency, lead type (unipolar vs. bipolar), electrocautery type, anatomic location of the biopsy, and urgency of the procedure. 1
Ensure a designated person is responsible for pacemaker programming decisions before and after surgery in your institution. 1
Procedures Without Electromagnetic Interference
For biopsy techniques that do not involve electrocautery (such as core needle biopsy, fine needle aspiration, or endoscopic biopsy without cautery), no special pacemaker precautions are required beyond standard procedural monitoring. 1, 2