- ICD Management
Link:frcamindmaps.org/patientconditions2/pacemakers/pacemakers.html
- Many of these patients will have a poor LV
- In addition to defibrillation function, they may have bipolar antibradycardia pacing (as with PPM) and antitachycardia pacing to pace-terminate VT
- Indications for insertion
- VF or Sudden cardiac death survivors (SCD)
- VT causing syncope not related to MI
- Minimally symptomatic VT with LVEF <35%
- Long QT and FH of SCD
- Brugada syndrome
- HOCM with VT/VF in the absence of reversible cause or with FHx of SCD
- There is no industry wide standardisation for the application of a magnet over an ICD so liase with cardiology services.
- Management
- Again, MRI is contraindicated
- The defibrillation and anti-tachy functions should be disabled if diathermy is to be used
- Important also in lithotripsy and ECT
- Ensure external defib is available
- Should not use TENS machines
- Manage in a HDU until the defib is switched back on
- Coding
- I
- Shock chamber
- O = none
- A = atrium
- V = ventricle
- D = dual
- II
- Anti-tachy pacing chamber
- III
- Tachy detection
- Electrocardiographic
- Haemodynamic
- IV
- Anti-Brady pacing chamber
- CEACCP
Link:ceaccp.oxfordjournals.org/content/1/6/166.full.pdf