Management of patients receiving implantable cardiac defibrillator shocks: Recommendations for acute and long-term patient management

Abstract

AF : Atrial fibrillation ATP : Antitachycardia pacing CRT : Cardiac resynchronization therapy EHRA : European Heart Rhythm Association ES : Electrical storm HRS : Heart Rhythm Society ICD : Implantable cardiac defibrillator SCD : Sudden cardiac death SSRI : Selective serotonin receptor inhibitor VF : Ventricular fibrillation VT : Ventricular tachycardia This expert consensus aims to provide guidance for the management of patients receiving one or multiple shocks from an ICD. The document expresses the view of a multidisciplinary group of experts in the fields of general adult cardiology, ICD treatment, invasive electrophysiology, and psychosomatic medicine. A variety of clinical settings, including emergency medicine, general cardiology, and interventional electrophysiology, are addressed as well as the different groups of clinicians involved in the care of these patients. To cover different levels of expertise in ICD treatment, it is intended to provide comprehensive information ranging from a basic explanation of how an ICD works to specialist advice for device programming. Almost 30 years after the first human implants, ICD therapy has become the treatment of choice in patients at risk of developing malignant ventricular arrhythmias.1,2 Accordingly, the number of patients implanted with an ICD has increased substantially over the past decade,3 mainly as a consequence of the expansion of ICD indications into the field of primary prevention of SCD in patients with decreased left ventricular function. In 2008, ∼120 000 patients received an ICD worldwide.3 As a result of the growing number of ICD patients, ICD-related problems are increasingly encountered and patients with one or multiple shocks are to day frequently seen at emergency departments, hospital wards, or ICD clinics. Therefore, personnel working in these environments should have specific knowledge concerning the management of ICD-related problems. Table 1 summarizes the most common causes of ICD shocks. Trials reported appropriate therapies in 17–64% of patients, whereas inappropriate shocks, most often caused by supraventricular tachycardia, occurred in 10–24%.4 Among patients enrolled in primary prevention ICD trials, women experienced less appropriate ICD interventions than men.5 Modern device algorithms facilitate effective termination of VT without shock delivery by ATP, discrimination …