Frequency of pacemaker malfunction associated with monopolar electrosurgery during pulse generator replacement or upgrade surgery Yun Lin 1 & Daniel P. Melby 2 & Balaji Krishnan 3 & Selcuk Adabag 3 & Venkatakrishna Tholakanahalli 3 & Jian-Ming Li 3 Received: 29 December 2016 /Accepted: 5 March 2017 # Springer Science+Business Media New York 2017 Abstract Purpose The aim of this study is to investigate the frequency of electrosurgery-related pacemaker malfunction. Methods A retrospective study was conducted to investigate electrosurgery-related pacemaker malfunction in consecutive patients undergoing pulse generator (PG) replacement or up- grade from two large hospitals in Minneapolis, MN between January 2011 and January 2014. The occurrence of this pace- maker malfunction was then studied by using MAUDE data- base for all four major device vendors. Results A total of 1398 consecutive patients from 2 large ter- tiary referral centers in Minneapolis, MN undergoing PG re- placement or upgrade surgery were retrospectively studied. Four patients (0.3% of all patients), all with pacemakers from St Jude Medical (2.8%, 4 of 142) had output failure or inap- propriately low pacing rate below 30 bpm during electrosur- gery, despite being programmed in an asynchronous mode. During the same period, 1174 cases of pacemaker malfunctions were reported on the same models in MAUDE database, 37 of which (3.2%) were electrosurgery-related. Twenty-four cases (65%) had output failure or inappropriate low pacing rate. The distribution of adverse events was loss of pacing (59.5%), reversion to backup pacing (32.4%), inappro- priate low pacing rate (5.4%), and ventricular fibrillation (2.7%). The majority of these (78.5%) occurred during PG replacement at ERI or upgrade surgery. No electrosurgery- related malfunction was found in MAUDE database on 862 pacemaker malfunction cases during the same period from other vendors. Conclusions Electrosurgery during PG replacement or up- grade surgery can trigger output failure or inappropriate low pacing rate in certain models of modern pacemakers. Cautions should be taken for pacemaker-dependent patients. Keywords Asystole . Electromagnetic interference . Pacemaker replacement . Electrosurgery Abbreviations PG Pulse generator CRT-D Cardiac resynchronization therapy EMI Electromagnetic interference ERI Elective replacement indicator EOL End of life MAUDE The United States Food and Drug Administration Manufacturers and User Facility Device Experience SJM St Jude Medical 1 Introduction Electromagnetic interference (EMI) is of great concern in pacemaker-dependent patients. Hermetic shielding, frequency filters, interference rejection circuits, and bipolar sensing have largely rendered modern pacemakers resistant to EMI [1–3]. Monopolar electrosurgery is the most common source of EMI and pacemaker interaction in the operating room. A variety of pacemaker malfunctions from intraoperative monopolar elec- trosurgery such as failure to pace, damage to device circuitry, inappropriate pacing and sensing, device re-programming or * Jian-Ming Li lixxx261@umn.edu 1 Beijing Anzhen Hospital, Capital Medical University, Beijing, China 2 Minneapolis Heart Institute, Minneapolis, MN, USA 3 Division of Cardiology, Veterans Affairs Medical Center, University of Minnesota, One Veterans Drive, Minneapolis, MN 55417, USA J Interv Card Electrophysiol DOI 10.1007/s10840-017-0241-y