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

Comments

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