Emergencies related to implantable cardioverter-defibrillators

Implantable cardioverter-defibrillators (ICDs) have become the dominant the rapeutic modality for patients with life-threatening ventricular arrhythmia s. ICDs are implanted using techniques similar to standard pacemaker implan tation. They not only provide high-energy shocks for ventricular fibrillati on and rapid ventricular tachycardia, but also provide antitachycardia paci ng for monomorphic ventricular tachycardia and antibradycardia pacing. Devi ces incorporating an atrial lead allow dual-chamber pacing and better discr imination between ventricular and supraventricular tachyarrhythmias. Intens ivists are increasingly likely to encounter patients with ICDs. Electrosurg ery can be safely performed in ICD patients as long as the device is deacti vated before the procedure and reactivated and reassessed immediately after ward. Prompt and skilled intervention can prove to be life-saving in patien ts presenting with ICD-related emergencies, including lack of response to v entricular tachyarrhythmias, pacing failure, and multiple shocks. Recogniti on and treatment of tachyarrhythmia can be temporarily disabled by placing a magnet on top of an ICD. The presence of an ICD should not deter standard resuscitation techniques. Multiple ICD discharges in a short period of tim e constitute a serious situation. Causes include ventricular electrical sto rm, inefficient defibrillation, nonsustained ventricular tachycardia, and i nappropriate shocks caused by supraventricular tachyarrhythmias or oversens ing of signals. ICD system infection requires hardware removal and intraven ous antibiotic therapy. Deactivation of an ICD with the consent of the pati ent or relatives is reasonable and ethical in terminally ill patients.