To the Editor:
I read with great interest “Initial Experience of an Anesthesiology-based Service for Perioperative Management of Pacemakers and Implantable Cardioverter Defibrilators” by Rooke et al.1 At our medium-sized hospital, the anesthesia group has been providing cardiovascular implantable electronic device service since 2010. All members of the group are expected to perform this service on their patients. We received training and equipment from the manufacturers, but nothing as rigorous as what you describe. With around an hour of training on each device, we were competent to (1) interrogate to evaluate settings, (2) decide upon and initiate an appropriate deactivation of function, (3) initiate appropriate reactivation of function, and (4) confirm whether the settings on discharge were the same as those on initial interrogation. Our preoperative testing department reviews device information with patients before their arrival, and all patients must have an interrogation completed within the last 6 months. On the rare occasion that we find problems with any settings, we contact the company representative and treating cardiologist. All training sessions were videotaped and can be reviewed by the providers as a refresher. While I appreciate the extra work your providers did to obtain a deeper understanding of these devices and their management, I don’t know if that is a realistic or necessary goal for most groups. Waiting for the cardiology team or a company representative, who usually just places a magnet and says, “Good to go,” isn’t a good solution either. This service has been a huge improvement to our previous process and is looked upon favorably by the hospital administration. I would recommend that all practices seek a pathway to offering these abilities by whatever means the administration feel comfortable with.
The author declares no competing interests.