Radiofrequency Cautery: A Safe Option for Patients With Indwelling Devices

The increasing prevalence of non-cardiac implantable electrical devices (NCIEDs), including deep brain stimulators (DBS), spinal cord stimulators (SCS), and an increasing list of other devices, presents a significant challenge to conscientious perioperative care teams. The major anticipated operative complications of having a pre-existing indwelling device are twofold. For the first category, there is the profound threat of direct thermal injury to tissue surrounding the device in question, as well as the lateral thermal spread. Of course, when the surrounding tissue is neural and may involve deep brain structures or spinal cord structures, these concerns are all the more pressing. As for the second category of anticipated danger, there is the concern of destructive interaction between electrocautery and the device itself. Considering the total investment made for the patient to acquire an implantable device and follow-up for adjustment and tuning, as well as the potential for uncontrolled or unintentional delivery of electricity, this is a significant concern. Such interactions could conceivably lead to worsened control of pre-existing neurologic conditions or chronic pain, making a recovery to baseline unpredictable or even impossible without further post-operative intervention. We present the case of a 56-year-old male patient with diabetic neuropathy treated with SCS and Parkinson's disease treated with DBS undergoing triple-vessel coronary artery bypass grafting (CABG). Due to concerns of potential interaction between the cautery device and the NCIEDs, causing direct thermal injury as well as device malfunction, both indwelling devices were powered down pre-operatively. Furthermore, although bipolar electrocautery is a relatively safe and more widely known option for patients with NCIEDs, the caveat of poor hemostasis was presented by the surgical team. With this in mind, the decision was made to proceed with PlasmaBlade (Medtronic, Minneapolis, MN) monopolar radiofrequency cautery, which according to its manufacturer, is notably less likely to cause damage to NCIEDs. The patient tolerated cardiac surgery with no bleeding complications or unintended consequence to the implanted devices, nor was there any apparent or suspected thermal injury to the tissue surrounding the devices.