Practice advisories are systematically developed reports that are intended to assist decision-making in areas of patient care. Advisories provide a synthesis of scientific literature and analysis of expert opinion, clinical feasibility data, open forum commentary, and consensus surveys. This updated advisory focuses on the perioperative management of the patient who has a pre-existing cardiac implantable electronic device (CIED) for the treatment of a bradyarrhythmia, tachyarrhythmia, or heart failure. It applies to all patients with a CIED receiving general or regional anesthesia, sedation, or monitored anesthesia care. Both inpatient and outpatient procedures are addressed by this update.

A focused preoperative evaluation for a patient with a CIED should be performed, consisting of the following: (a) establishing whether a patient has a CIED; (b) defining the type, manufacturer, and primary indication for CIED placement; (c) determining whether a patient is pacing-dependent; and...

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