Authors: Alfred A M et al.
Cureus 17(10): e95809, October 2025. DOI: 10.7759/cureus.95809
This case report describes perioperative management for a 56-year-old man with two non-cardiac implantable electrical devices (NCIEDs)—a deep brain stimulator (DBS) and a spinal cord stimulator (SCS)—undergoing CABG. To mitigate risks of device malfunction and thermal injury from surgical energy devices, both stimulators were powered down preoperatively. Because endoscopic radial artery harvest required monopolar electrocautery, the team instead chose open saphenous vein harvest and used a monopolar radiofrequency device (PlasmaBlade) with the return pad placed contralateral to and distant from all implant components. Hemostasis was adequate, no transfusion was required, and there were no device malfunctions or signs of thermal injury; devices were reactivated postoperatively without issue.
The discussion reviews hazards of energy-device interactions with NCIEDs (electrocautery, defibrillation/cardioversion, neuromonitoring, ECT, MRI), compares alternatives (bipolar cautery, ultrasonic scalpel/Harmonic, diathermy, RF devices like PlasmaBlade), and emphasizes manufacturer guidance, grounding pad placement, and knowledge of generator/lead locations. It also highlights lead impedance concepts and the role of postoperative interrogation when interference is suspected. The report supports radiofrequency cautery as a viable option when standard monopolar electrocautery is undesirable and bipolar performance is inadequate, provided precautions are taken.
What You Should Know:
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Power down or place NCIEDs in safe mode; locate all generators and leads and plan current paths and grounding pad placement accordingly.
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When feasible, favor lower-risk energy tools (bipolar, ultrasonic). Monopolar RF cautery (e.g., PlasmaBlade) may be acceptable with precautions and distant pad placement.
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Coordinate with device manufacturers and consider pre/postoperative interrogation; monitor lead impedance when relevant.
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Team communication can enable workflow changes (e.g., switching harvest technique) that avoid higher-risk energy use without compromising hemostasis.
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