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Pacemaker and monopolar diathermy — FRCA Final MCQ

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HardPerioperative MedicinePacemaker and monopolar diathermyFRCA Final

A 69-year-old man with a dual-chamber pacemaker is listed for transurethral resection of bladder tumour using monopolar diathermy. He is pacemaker-dependent and the operating site is below the umbilicus. What is the most appropriate management?

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Correct answer: A — Check device status and use a peri-operative plan with diathermy precautions

Pacemaker-dependent patients need device identification, recent interrogation where appropriate and a plan for electromagnetic interference. Surgery below the umbilicus carries lower risk, but monopolar diathermy still requires precautions such as return electrode positioning and short bursts. Magnet or reprogramming decisions depend on device type and pacing dependence. The aim is to prevent inhibition of pacing and ensure rescue equipment is available.

Reference: Association of Anaesthetists cardiac implantable electronic device guidance; RCoA Final FRCA Syllabus 2026