Defibrillators, Implantable, Emergency Medicine

Robert D. Sidman and Lawrence S. Rosenthal Reviewed 06/2017
 


Basics

Description

  • An implantable cardiac device (ICD) is a small battery-powered electrical impulse generator implanted SC in patients at risk of cardiac arrest from cardiac arrhythmias.

  • Lead(s) are po...

Diagnosis

Signs and Symptoms

  • Felt bad before shock and good after: Likely appropriate therapy

  • Felt good before and after shock: Likely inappropriate therapy

  • Felt bad before and after shock: Consider ongo...

Treatment

Pre-Hospital

Following an ICD electrical discharge: 
  • IV access

  • Continuous EKG monitoring

  • Advanced cardiac life support (ACLS) protocols

Initial Stabilization/Therapy

  • ACLS protocols

  • Magnet applicati...

Follow-Up

Disposition

Admission Criteria

  • Therapy-related:

    • Ongoing/suspected cardiac ischemia or heart failure

    • Multiple ICD shocks and initiation of antiarrhythmic agents for VF/VT or other SVT

    • Treat underl...

Pearls and Pitfalls

  • Aspiration of device pocket is not recommended.

  • Care should be taken not to deliver external shocks directly over the device, as it may shunt energy away from the heart.

Additional Reading

  • Epstein  AE, DiMarco  JP, Ellenbogen  KA, et al. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnor...

Codes

ICD9

  • V45.02 Automatic implantable cardiac defibrillator in situ

  • V53.32 Fitting and adjustment of automatic implantable cardiac defibrillator

  • 996.04 Mechanical complication of automatic implantable ...

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