Evaluation and Management of Patients After Implantable Cardioverter-Defibrillator Shock

Abstract

Through the use of effective ICD programming and antiarrhythmic medications, the occurrence of ICD shocks can be reduced while maintaining the lifesaving ability of the ICD. A basic understanding of the range of available options is fundamental for evaluation and management of the patient who has received an ICD shock.

Prognostic Significance of Implantable Cardioverter-Defibrillator Shocks

“…3 In case of an isolated shock without change in clinical status or symptoms, evaluation should generally occur within a few days. 4 Multiple ICD shocks or shocks associated with worsening HF symptoms, syncope, angina, or electrical storm warrant emergent medical attention. 4 Device interrogation will reveal whether the ICD shock was appropriate or inappropriate.…”

“…4 Multiple ICD shocks or shocks associated with worsening HF symptoms, syncope, angina, or electrical storm warrant emergent medical attention. 4 Device interrogation will reveal whether the ICD shock was appropriate or inappropriate. While there is still some debate regarding the definition of an appropriate shock, most authors agree that any shock for ventricular tachycardia (VT) or ventricular fibrillation (VF) is considered appropriate.…”

ACCF/AHA/ACP/HFSA/ISHLT 2010 Clinical Competence Statement on Management of Patients With Advanced Heart Failure and Cardiac Transplant

“…These and other common clinical developments mandate not only a change in the course of HF therapy, but also discussion with the clinician managing the ICD to ensure appropriate implementation and adjustment of detection algorithms, and upgrading or inactivation of the device. The HF specialist must understand the risks and benefits of the various options available for management of atrial and ventricular arrhythmias in the patient with HF (109,111,113). Cardiac electrophysiologists involved in the care of patients with HF sometimes seek input from the HF specialist to select the appropriate treatment.…”

ACCF/AHA/ACP/HFSA/ISHLT 2010 Clinical Competence Statement on Management of Patients With Advanced Heart Failure and Cardiac Transplant

“…109,111,113 Cardiac electrophysiologists involved in the care of patients with HF sometimes seek input from the HF specialist to select the appropriate treatment. Ongoing arrhythmias may prompt additional diagnostic testing, such as coronary imaging or myocardial biopsy.…”