Electrosurgery and pacemaker safety is a recurring question for operating teams, because high-frequency current can interfere with implanted cardiac devices. The risk is manageable with planning, but it requires coordination between the surgeon, anaesthesia and the cardiology or device clinic. This article outlines the general principles used in operating rooms across the UAE and GCC. It is not patient-specific advice; always follow your hospital protocol and the device manufacturer's guidance.
How electrosurgery can affect implanted devices
Electrosurgical current is a radio-frequency signal. A pacemaker or implantable cardioverter-defibrillator (ICD) can mistake that signal for cardiac activity, which may inhibit pacing, trigger inappropriate shocks, cause the device to revert to a back-up mode or, rarely, damage its circuitry. The likelihood increases when the current path passes near the generator or leads, when the active electrode is close to the device, and with prolonged monopolar activation.
For this reason implanted-device patients are flagged at pre-operative assessment, and their device type, dependency on pacing and recent interrogation should be known before the day of surgery.
Prefer bipolar where the procedure allows
Bipolar instruments confine the current between the instrument tips, so only a negligible amount flows through the body. Where the operation can be done with bipolar forceps, bipolar scissors or bipolar vessel sealing, this is generally the lowest-risk approach. The BOWA BiZZER bipolar scissors, for example, cut, dissect and coagulate with current confined between the blades, and our guide to bipolar electrosurgery outlines where it can replace monopolar techniques.
If monopolar is unavoidable, use the lowest effective power, short bursts of a few seconds, and cut rather than prolonged coagulation modes where appropriate.
Return pad placement and current path
Place the return electrode so the current path between the surgical site and the pad does not cross the chest or the device. For surgery below the umbilicus the pad is usually positioned on the thigh or buttock; for head and neck surgery this is harder, and monopolar use above the umbilicus carries more risk. Keep cables and the pad lead away from the device and its leads.
Check that the return electrode alarm is clear before every activation. Generators with neutral-electrode monitoring, such as the BOWA ARC 400 family, help keep the return path secure; see how contact monitoring works.
- Pad away from the chest and device
- Short bursts, lowest effective power
- Bipolar if clinically suitable
- Keep cables and leads separated
Argon plasma coagulation and implanted devices
Argon plasma coagulation is delivered with a monopolar circuit, so the same precautions apply: current path, short activations and a pad placed to avoid the device. The fact that the current is carried by an argon plasma does not remove the radio-frequency exposure. Discuss APC use with the anaesthetist and the device clinic beforehand.
Monitoring and device management
Standard ECG monitoring can be distorted during activation, so teams commonly add a pulse-based monitor such as pulse oximetry plethysmography or an arterial line to confirm perfusion. Depending on the device and procedure, the cardiology service may reprogram the device or advise on a magnet; this must be decided by the device team, not improvised in theatre.
A defibrillator and external pacing capability should be available. After surgery, the device is checked according to the local protocol, particularly after monopolar use near the device or any inappropriate therapy.
Planning, training and equipment
A written pathway for implanted-device patients, with checklists at pre-assessment, in theatre and in recovery, improves consistency. Staff should know where this protocol is and who to call. Equipment decisions also matter: a generator that offers precise low-power settings and reliable pad monitoring supports safer practice, and regular maintenance keeps alarms and outputs verified. Contact Beckfinity's specialists if you would like to review which bipolar and monopolar configurations suit your lists.
Frequently asked questions
Is bipolar electrosurgery safe for pacemaker patients?
It is generally considered the preferred option because current stays between the instrument tips, but each case should still be planned with the device team.
Where should the return pad go?
Place it so the path between the surgical site and the pad avoids the chest and the device, for example on the thigh for lower abdominal surgery.
Does argon plasma coagulation affect pacemakers?
APC uses a monopolar circuit, so the same precautions apply as for monopolar electrosurgery.
Who decides whether the device should be reprogrammed?
The cardiology or device clinic, in agreement with the surgical and anaesthesia teams, according to hospital protocol.
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