The Impact of Colonscopic Electrocautery on Pacemaker Function

The Impact of Colonscopic Electrocautery on Pacemaker Function Navin Kumar, Hemant Roy, Alan Zunamon, Eva Gliwa, Mick Meiselman, Michael Goldberg, Tat-Kin Tsang, Randall Brand Background: While some guidelines advocate inactivation of pacemakers prior to use of electrocautery for colonoscopic polypectomy, this is not done by most endoscopists. These recommendations are based upon expert opinion, small non-blinded studies and anecdotal case reports. In order to provide evidencebased insight into this issue, we performed a pilot study analyzing the risk of electrocardiographic abnormalities during cautery. Methods: A total of 19 patients were enrolled in this study. Each patient had rhythm strips run preand post-colonoscopy, when the cecum was reached and during all episodes of cautery use. Continuous ECG rhythm monitoring was also performed during the colonoscopy. The technique (continuous vs. brief, short bursts) of cautery was dependent on the endoscopist preference. The grounding electrode was placed on the patient’’s buttock or thigh. Identified preand post-procedure strips along with either an unidentified cecal (control) or cautery strip were grouped together and evaluated by a cardiologist blinded to the cautery status of the third strip. Results: Eight of the 19 patients underwent a total of 18 polypectomies using electrocautery. No incidence of pacemaker dysfunction or change in cardiac rhythm occurred in the control or cautery groups. All 19 patients tolerated each colonoscopy without any other adverse cardiac events or complications. Conclusion: This study suggests that electrocautery use is safe in patients with pacemakers as along as the electrocautery pad is positioned on the lower part of the body away from the pacemaker. To our knowledge this is the first blinded, prospective trial demonstrating the safety of performing electrocautery during colonoscopy in patients with a pacemaker. If confirmed with larger patient numbers, this would strongly argue for new practice recommendations.