Implantable Cardioverter Defibrillator (ICD) Reprogramming Guidelines Lauren Butler.

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Presentation transcript:

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?