michael s
(Michael S)
#1
form of atrial fibrillation that is commonly associated with rapid
rates at its onset. Occasionally, RF ablation of the AV node is
necessary. Beta adrenergic blockers should be an integral part of
therapy in most ICD patients.
2.Recognise ICD—drug interactions
Antiarrhythmic drugs have the potential for interacting with an
ICD in several ways. Drugs such as flecainide and amiodarone
can increase pacing and defibrillation thresholds. In patients with
a low margin of safety for these parameters, use of these drugs
may result in failure of pacing or defibrillation. Secondly, these
drugs can slow the rate of ventricular tachycardia below the
programmed rate threshold for detection by the ICD; failure of
arrhythmia detection can result. Some rarer interactions include
alteration of the T wave voltage by drugs or hyperkalaemia
resulting in double counting and inappropriate shocks.
3.ICD wound management
As an implanted device, the system is susceptible to infections.
Pain and inflammation of the skin over the ICD may herald an
infective process. Similarly, unexplained fever, particularly
staphylococcal septicaemia may indicate endocarditis involving
the leads and/or tricuspid valve.
