Perioperative care of the patient with a cardiac pacemaker or ICD

Electronic miniaturization has permitted the design and use of sophisticated electronics in patients who have need for artificial pacing and/or automated cardioversion/defibrillation of their heart. These devices are no longer confined to keeping the heart beating between a minimum rate (pacing function) and a maximum rate (ICD functions), as they are being used as therapy to improve the failing heart. The aging of the population and our ability to care for a patient with increasingly complex disease suggest that we will be caring for many more patients with these devices, and we must be prepared for this situation. Safe and efficient clinical management of these patients depends upon our understanding of implantable systems, indications for their use, and the perioperative needs that they create.