Implantable cardioverter defibrillator (ICD) Pearls

Last 7 years

Deliver 30–45J max

Indications

• EF <30% and prior MI
• EF <35% and prior MI and NYHA Class >1
• EF <40% and prior VTach/VFib or inducible at EP testing

AICD May Not Fire (High Defibrillation Threshold) when energy level sensed is too high to safely fire. Causes:

• Antiarrhytmics
• Cocaine/Illicit Drug Use
• Pneumothorax or COPD (high impedence)
• Poor lead placement
• Acidosis/Electrolyte abnormality
• Hypoxia
• Heart Failure
• EF <35% and prior MI and NYHA Class >1

some more pearls:

• AICD shock can cause transient EKG changes
• Magnet disables AICD function but not pacing function (puts it into asynchronous mode with fixed pacing).
• Place magnet, will beep, each beep is it sensing the QRS. Once constant tone, AICD is disabled. Re-place magnet for 30 seconds to re-activate
• If 1 magnet doesn’t disable (pt obese), place two magnets on top of each other.
• Shocks during CPR are not dangerous to provider.
• Place defibrillation pads 10cm from the pulse generator