Implantable Cardioverter Defibrillator (ICD) Emergencies
Patients who receive a single shock of their ICD should be seen by their cardiologist for urgent interrogation. They are actually instructed not to visit the ED - David Bussé MD
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Pacemaker and AICD management in the Emergency Department
Patients with ICDs who receive a single shock without the presence of cardiac-related symptoms do not need immediate electrophysiology referral. These patients can be observed in the ED and referred within the week. However, if patients received multiple shocks or have cardiac-like symptoms such as dyspnea, chest pain, or weakness, a more thorough workup should be initiated to search for underlying etiologies. The patient should be placed on a cardiac monitor in the ED until the device can be interrogated. Three or more appropriate shocks in a 24 hour period is termed an “electrical storm,” and patients should be evaluated for electrolyte abnormalities, acute coronary syndrome, and medication…
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ECG Pointers: ICDs and when they malfunction
When the patient is hemodynamically stable, differentiate between appropriate and inappropriate shocks by interrogating the device. Interrogation can confirm true shocks vs. phantom shocks by accessing the device’s stored ECGs.
Articles of Interest
Complications of Implantable Cardioverter Defibrillators in the Emergency Department Setting
Complications seen shortly after placement include bleeding in the area of the insertion or pericardial bleeding, pneumothorax/hemothorax seen one to four days post insertion, and cardiac perforation. Longer-term complications include Twiddler’s syndrome (often leading to lead fracture), infection (Staphylococcus aureus or Streptococcus epidermidis), thrombosis, lead failure, or battery depletion.
Emergencies of Implantable Cardioverter Defibrillator
Inappropriate shock is the most common adverse effect observed among ICD patients and the incidence varies from 13% to 22%. Inappropriate shock may be caused by misdiagnosis of supraventricular tachycardia (SVT) as VT/VF or inappropriate sensing originating from internal and external sources.
