DS14 Shocking practices: a survey of cardiac device management in dermatological surgery

Abstract Electromagnetic interference with cardiac implantable electronic devices (CIEDs) during dermatological surgery is considered low risk, given that operators limit to short bursts of diathermy (avoiding monopolar if required) and as patients are awake and able to communicate symptoms. This survey of 71 dermatological surgeons across the UK explored current practices, risks and outcomes in managing patients with CIEDs during dermatological procedures. We distributed an 18-question survey to dermatological surgeons across the UK using professional networks including the British Society for Dermatological Surgery (BSDS), the Welsh Dermatology Forum and regional Grand Round email networks. Respondents had a wide range of experience in dermatology, from 0.5 to 39 years (mean 13.6). They performed a mean of 1.32 surgical lists per week (range 0.25–4), treating 5.78 patients per list (range 2–8), equating to approximately 91.5 patients per respondent over a 3-month period. Over a 3-month period, an estimated 1.81 patients with CIEDs (range 0–15) were treated per respondent, covering approximately 129 CIEDs. Electrosurgical tools were commonly used: 17 respondents (27%) used monopolar diathermy without a return plate (e.g. Hyfrecator), 24 (38%) used monopolar diathermy with a return plate, and 22 (35%) used heat cautery. Despite the theoretical risks, no adverse events were reported, such as device interference or patient shocks. The survey represented 965 years of dermatological surgery experience, during which the surgeons performed approximately 382 837 procedures, including 6987 procedures on patients with CIEDs. Despite this extensive experience, no adverse outcomes were reported. Device deactivation practices varied widely: 5% always deactivated defibrillators, 41% never did, and 32% electively deactivated depending on factors such as proximity to the surgical site or the use of electrosurgical energy. Monitoring practices were also inconsistent: 31% reported no monitoring, 20% monitored clinical status only, 13% used pulse oximetry, 9% involved a cardiac technician, and 3% used a continuous electrocardiogram. Regarding guidelines, 37 respondents (52%) reported having local protocols for CIED management, while 34 (48%) either did not have or were unaware of such guidelines. This survey suggests that dermatological surgery, including the use of electrosurgery, appears safe for patients with CIEDs. This aligns with 2017 and 2023 BSDS and British Heart Rhythm Society guidance, which found no reported adverse events related to electromagnetic interference following a literature review, member survey and consultation with the Medicines and Healthcare products Regulatory Agency (MHRA). The wide variation in device management and monitoring practices, coupled with lack of adverse outcomes, indicates a need to re-evaluate current practice. Future studies should focus on developing clinical evidence-based, standardized protocols that balance patient safety with practical considerations in dermatological surgery.