To the Editor: 

I read with great enthusiasm the updated advisory on the management of cardiac implantable electronic devices.1In March 2006, I was a lucky person who survived an out-of-hospital sudden cardiac arrest while on Air Force Reserve duty. Now I have a Medtronic (Minneapolis, MN) automatic implantable cardioverter-defibrillator.

I would like to add a few points:

  1. In 2006, there were reported cases of lead fractures with Medtronic Fidelis leads.2Although the rate was only 3%, a danger is that people with lead fractures could receive premature shocks or no shocks when needed. Many of these devices have programmable alarms that warn of lead fracture.

  2. Because the devices may be implanted under the pectoralis major muscle, they may not be palpated.

  3. These devices are interrogated on a regular basis, which is generally quarterly. Patients now can use a device at home to interrogate the implantable cardioverter-defibrillator and then send the information to a cardiologist in the community or at a tertiary referral center.

  4. Finally, I advise all physicians to maintain their advanced cardiac life support certification. It saves lives—I am living proof.

1.
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
2.
Maisel WH: Semper fidelis: Consumer protection for patients with implanted medical devices. N Engl J Med 2008; 358:985–7
Copyright © 2011, the American Society of Anesthesiologists, Inc.