Transcript Implantable Cardioverter Defibrillator (ICD) Reprogramming

Implantable Cardioverter
Defibrillator (ICD)
Reprogramming Guidelines
Lauren Butler
• Acute and primary care trusts
• Guidance outlines the situations in which
reprogramming
or
withdrawal
of
Implantable
Cardioverter Defibrillator
therapy is required
• The procedures to follow and personnel to
contact is held within the guidance
• Routine reprogramming for optimisation of device
settings
• Switch off (withdrawal of therapy) during routine
surgery/treatment
• Switch off (withdrawal of therapy) device due to
death of patient
• Switch off (withdrawal of therapy) device due to
end stage heart failure
• Emergency reprogramming of detection or therapy
parameters due to Ventricular Tachycardia (VT)
• Emergency reprogramming/application of magnet
during emergency surgery
Untreated VF
• If the patient has an episode of Ventricular
Fibrillation (VF) and the device fails to
deliver therapy or if the shock therapy fails,
immediate external Direct Current (DC)
defibrillation should be delivered
• not within the remit of this guidance
Routine reprogramming for
optimisation of device
• Tertiary center
• Outpatients clinics – pacing & ICD
• Possible developments in DGH trusts may
lead to routine follow up taking place
elsewhere
Switch Off (Withdrawal Of Therapy)
During Routine Surgery/Treatment
• programming the device to prevent
detection of all incoming signals and
ensures any noise entering the device from
diathermy
• This does prevent the device from
delivering any therapies and the device is
effectively switched off
• Reprogramming back post op is required
Switch Off (Withdrawal Of Therapy)
Of Device Due To Death Of Patient
• device requires deactivation before removal
by mortuary or undertaker staff
• cremation is not possible with an ICD in
situ
• ICDs should always be deactivated in the
event of the patient’s death, as towards
battery end of life it will emit an audible
bleep every day
Switch Off (Withdrawal Of Therapy)
Of Device Due To End Stage Heart
Failure
• Combined with CRT which is not deactivated at
end of life
• Discussed at implant possible withdrawl of ICD
therapy at EOL
• The decision is reversible
• Involvement of relatives/carers should be
considered
• Withdrawl of anti-arrhythmic therapy will increase
amount of therapy delivered
Emergency Reprogramming Of
Detection Or Therapy Parameters
Due To Ventricular Tachycardia
• External emergency DC shock should be
delivered if necessary
• VT Storm – painful repetitive shocks
• Consideration given to delivery of
shocks/therapy through the device
• Missed detection slow VT will require
reprogramming
Emergency Reprogramming/Application
Of Magnet To Suspend Therapy During
Emergency Surgery
• Often out of hours
• Magnet application –temporary measure
• ICD check performed post op
Other issues
•
•
•
•
•
Lone working
Medical consent
Documentation
Tertiary center support
Out of area contacts
ANY QUESTIONS?