A pacemaker and an Automated Implantable Cardioverter Defibrillator (AICD) are two types of cardiac devices used to manage heart rhythm disorders.

Pacemaker: A pacemaker is a small device that's placed in the chest to help control abnormal heart rhythms. It uses electrical pulses to prompt the heart to beat at a normal rate. Pacemakers are typically used to treat bradycardia (slow heart rate). The device consists of a battery, a computerized generator, and wires with sensors at their tips. These wires are inserted into a vein under the collarbone and guided to the heart, where they're permanently anchored.
Automated Implantable Cardioverter Defibrillator (AICD): An AICD is similar to a pacemaker but has additional capabilities. It's used in people who are at risk of life-threatening arrhythmias like ventricular tachycardia or ventricular fibrillation. Besides functioning as a regular pacemaker, an AICD can deliver shocks to the heart if it detects a dangerous rhythm. It helps in restoring the normal heart rhythm and is a form of treatment and prevention for cardiac arrest.

Factors that may alter the threshold of cardiac pacemakers:

Anesthetic Implications for Pacemaker and AICD Insertion

Anesthesia type: Sedation with a local anesthetic. Provider and surgeon preference

Airway: LMA or ETT may be needed

Preoperative:

Patients may have decreased cardiac reserve, coronary artery disease, ventricular dysfunction, cardiomyopathy, and valvular heart disease
Fluoroscopy will be used
The pacemaker ensures that the heartbeat will not go lower than a preset level
Transcutaneous pacing pads should be placed on patient
External defibrillator monitor on and ready for use
Have chronotropic drugs available (atropine, epinephrine, isoproterenol)
Avoid the use of negative inotropes

Intraoperative:

Supine position with head turned away from operative side
The proceduralist will infiltrate the skin with local anesthetic
Carefully monitor the EKG for sustained cardiac dysrhythmias
Tunneling part of the procedure is stimulating
When there is a concern for the subclavian/innominate vein patency, a venogram may be performed
If AICD, the cardiologist will indice V-tach or V-fib (deepen sedation prior to defibrillation)
EBL minimal

Postoperative:

Complications:

Sources:

Longnecker, D. E., Brown, D. L., Newman, M. F., & Zapol, W. M. (2012). Anesthesiology, 2nd ed.

Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice.

Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.).

Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult.

Ninja Nerd Nursing

Pacemakers

Asia Pacific Heart Rhythm Society

Permanent Pacemaker Implantation Tutorial