michael s
(Michael S)
#1
89 How do I follow up the patient with the
implantable cardioverter defibrillator?
Mark Squirrell
Follow up of the patient with an implantable cardioverter de-
fibrillator (ICD) demands an integrated team approach. The
cardiologist, technical staff and nurses involved should have a
wide experience and knowledge of pacemakers and general
cardiac electrophysiology. Current generation ICDs do not just
shock the heart but provide complex regimens of tachycardia dis-
crimination and anti-tachycardia pacing (ATP) as well as single
and dual chamber bradycardia therapy.
Routine follow up may occur in a tertiary centre or a local
hospital as long as the expert staff and necessary equipment such
as programmers and cardiac arrest kit are available. Follow up
should start before the device is implanted with an educational
programme and support for the patient and immediate family
members. Videos, information booklets and meeting other
patients with ICDs may be of benefit.
No consensus exists as to the interval between routine follow
ups. Previously the patient had to return every month or two to
have a capacitor reform. This is not now necessary, as all modern
ICDs will undertake this automatically. With most current
devices a 3 to 6 month interval is usual but treat each patient
according to their individual circumstances.
Good management of the ICD should aim to achieve the
following objectives:
11 Monitor the performance of the therapy delivered by the
device, look at the success and failure of the programmed
regimes and any acceleration of arrhythmias. Use this infor-
mation to optimise clinical effectiveness of the programming.
22 Measure necessary parameters of the ICD and leads to ensure
correct function. These should include lead impedance, shock coil
impedance (if possible non-invasively), battery voltage, charge
time, R and P wave amplitudes as well as pacing thresholds.
33 Review the intracardiac electrograms to ensure no inadvertent
sensing of noise or other interference.
44 Maximise device longevity by safe and effective reprogramming
of parameters.
