Commentary.

The article focuses on a couple of issues. First is that of involving the appropriate consultants to manage problems uncovered in the preoperative workup. For a patient with an implanted cardioverter/defibrillator to be managed properly, a whole team needs to be assembled, a complicated logistical plan has to be devised, and everything needs to be centrally coordinated and monitored by one person. Secondly, a real mine field can occur in a busy, regional referral surgery practice where patients may be required to come a long way to receive specialized care.