In this interview, EP Lab Digest speaks with Jay Dinerman, MD, FHRS about a new electrophysiology-related app called Magnet Master, which assists medical professionals in planning for surgery using electrocautery in patients with cardiac devices.
What is your involvement with Magnet Master?
Although my major role is as a practicing clinical cardiac electrophysiologist, I am also the medical director and one of the founders of Busy Being Born Solutions, the software publisher of this mobile app. Michael Portner and I co-founded Busy Being Born Solutions to develop our first apps, epTools and epTools Lite. These apps contain an ever-growing assortment of algorithms and reference guides useful to professionals who treat heart rhythm disorders.
How did the Master Magnet come about? How and why was the app developed?
Our device clinic had recently been alerted via remote monitoring to an ICD shock in a patient who had just returned home from the hospital after eye surgery. It was determined that the ICD had fired due to an interaction between electrocautery and the device. The patient, an engineer, wrote to the hospital afterward to determine what sort of practices were in place to prevent this from happening. Although the anesthesia and surgery departments had a policy regarding handling patients with cardiac implantable electronic devices (CIEDs), a task force was then created, comprising of hospital administration, anesthesia, surgery, and electrophysiology, to reexamine this process in our hospital.
Those who assist with device management — particularly electrophysiologists, device nurses, and manufacturer representatives — are aware not only of the unfortunate incidence of this type of occurrence, but also other issues such as failure of reprogramming devices to their original settings following surgery. Unfortunately, this sometimes includes lack of re-enabling tachycardia detection therapies in ICD patients.
Using guidelines proposed by the American Society of Anesthesiologists in collaboration with the American Heart Association and the Society of Thoracic Surgeons,1 we convened a task force that instituted recommended practices focusing on the type and manufacturer of CIED present, the patient’s underlying cardiac rhythm, and the site of surgery. We found that due to the multiple types of devices and manufacturers, the revised protocol needed to be very complicated. In order to simplify this process, we developed an app called the Magnet Master.
How is the Magnet Master app used? What are the capabilities of the app?
The user is asked to input four pieces of information regarding the patient’s device and type of surgery (Figure 1, left): this includes the type of device, the manufacturer of the device, if the surgery is above the umbilicus, and/or if the patient’s underlying cardiac rhythm makes them dependent on the pacemaker for support. The user then selects “continue” (located in upper right of screen) and is presented with a full report, including recommendations for the procedure as well as characteristics unique to the patient’s particular device (Figure 1, center). This includes recommendations regarding the type of electrocautery and whether a device magnet should be placed. In many instances, the simple placement of a device magnet is preferable to reprogramming the device, since this obviates the problem of forgetting to return the device to its initial setting following surgery. However, we have found that magnet use is a source of considerable angst for anesthesiologists and surgeons given their unfamiliarity with the various responses to magnet placement among the many different device manufacturers. Since the app provides information regarding exactly what to expect upon magnet placement, it mitigates many concerns regarding this practice.
Scrolling down the report screen (not shown), the user is provided with additional best practice considerations as well as links that will call the manufacturer for technical assistance if desired. A direct link to the consensus statement, upon which the app is based, is provided. Lastly, a field is presented to allow the user to input any additional information they feel may be useful when sharing the report.
Selecting “PDF” (located in upper right) on the report screen creates a PDF of the full report (Figure 1, right). By selecting the share icon on the upper right portion of the report screen, the report may be shared via printout, text message, or email.
Can you provide an example case illustrating how the Magnet Master is used?
Yes, I’ll provide two contrasting cases of how Magnet Master can fit into the perioperative workflow of typical device patients. The first example (presented in Figure 1) demonstrates how a patient can be easily managed by the surgical team without the need to find, contact, and receive recommendations from heart rhythm professionals, such as the manufacturer’s representative, electrophysiologists, and device nurses. In a second example, a 72-year-old female with a biventricular ICD and who is pacemaker dependent underwent a carotid endarterectomy; this patient could have been at risk for catastrophic intraoperative consequences of device-electrocautery interactions if a heart rhythm professional had not been notified about the case to institute temporary programming changes (e.g., program asynchronous pacing).
Who is the app useful for?
The app is particularly useful for anesthesiologists, CRNAs, surgeons, electrophysiologists, device nurses, and manufacturer representatives. Manufacturer representatives have told us that once users become comfortable with the app, they are called much less often to assist with perioperative management of device patients.
What is the cost of the app?
The app is available for $1.99 on iTunes. It is free for users who purchase epTools ($9.99).
What changes or improvements have you seen in the risk of CIED-electrocautery interactions since creation and utilization of this app?
Overall compliance with the policies and procedures developed by the task force at Huntsville Hospital occurs at nearly 100%. Since implementation of our use of the app, we are no longer seeing inadvertent ICD firings, nor are patients being discharged with their ICDs programmed with tachycardia detections off.
Where is the Magnet Master app in use — both throughout and outside of Huntsville Hospital Health System? What feedback have you received thus far?
Magnet Master is being used not only on our main campus, but at many of the affiliated hospitals throughout northern Alabama as well. I am very gratified to hear from our colleagues in the surgical suites about how the app has streamlined and provided greater comfort for the delivery of care to their patients.
Why is it important to address this issue in EP?
Throughout the healthcare continuum, electrophysiologists are asked to safely shepherd the care of patients with lifesaving CIEDs. Our responsibilities include offering education as well as our expertise to our colleagues.
Is there anything else you’d like to add?
Although not currently available, we hope to have an Android version of the app available soon. As always, we are always grateful for user suggestions on how to improve the apps.
- Crossley GH, Poole JE, Rozner MA, et al. The Heart Rhythm Society (HRS)/American Society of Anesthesiologists (ASA) Expert Consensus Statement on the perioperative management of patients with implantable defibrillators, pacemakers and arrhythmia monitors: facilities and patient management. Heart Rhythm. 2011;8(7):e1-18.