Timeframe: from early post-implantation and including emergency management of a patient with an ICD

Setting: outpatient setting, inpatient setting, and emergency department

Including:

complications after implantation

lead displacement; exit block; failure of sensing

infection and endocarditis

end-of-life care: device inactivation

Excluding: performing ICD implantation (specialist management)

performing full ICD interrogation and troubleshooting (specialist management)

• Medical expert

• Communicator

• Collaborator

• Professional

• Outline the algorithms of ICDs

• Explain the basic programmable features of ICDs

• Explain the principles of anti-tachycardia pacing

• Describe the lead types and configurations

• List the complications of ICD implantation

• Discuss the potential effects of exposure to electromagnetic radiation, including surgical diathermy, MR scanning, and airport security devices

• List the drugs with the potential to increase defibrillation threshold

• Explain the national regulations on driving (private and commercial) for a patient with an ICD

• Discuss when to upgrade an ICD to CRT

• Take a relevant history and carry out an appropriate physical examination

• Recognize surgical complications and arrange prompt re-referral to implanting cardiologist

• Manage a patient after a defibrillation event

• Manage a patient with an electrical storm

• Manage remote monitoring of ICD patients including recognition of lead failure, AF, VT, and others

• Recognize and manage pacing induced HF

• Interrogate the device:

  •   – To analyse defibrillator shocks and overdrive pacing activity

  •   – To identify inappropriate discharges

  •   – To detect arrhythmias

  •   – To anticipate battery depletion

• Advise on device management for patients scheduled to undergo cardiac or non-cardiac anaesthesia and surgery

• Activate MR safe mode

• Collaborate with non-medical cardiac physiologists in dealing with recall situations

• Contribute to end-of-life decisions with respect to inactivation of an ICD

• Collaborate with electrophysiologists, HF, and palliative care physicians and specialist nurses

• Help patients with ICDs to come to terms with their fears of painful and inappropriate shocks

• Advise patients on the lifestyle implications of having an ICD

• Advise patients on the palliative role of the ICD and on the possibility of device deactivation

• Direct observation/WBA (e.g. DOPS, Mini-CEX, fieldnotes)

• CbD (case-based discussion)/EbD (entrustment-based discussion)

• 4. Distant supervision