Station 3.8: Implantable devices Flashcards
Implantable devices
Clinical signs
What are the clinical signs of Implantable devices?
Implantable devices
This patient has had syncope. Please examine his cardiovascular system
- Incisional scar in the infraclavicular position (may be abdominal)
- Palpation demonstrates a pacemaker
- Signs of heart failure: raised JVP, bibasal crackles and pedal oedema
- Medic alert bracelet
- Local infection: red/hot/tender/fluctuant/erosion
Discussion - Nice Guidance
What nice guidance do you recommend for Implantable devices?
Implantable devices
This patient has had syncope. Please examine his cardiovascular system
Implantable cardiac defibrillators (ICD)
‘Shock box’ also delivers anti‐tachycardia pacing (ATP) – improves mortality
Discussion - Nice Guidance
What primary prevention do you recommend for Implantable devices?
Implantable devices
This patient has had syncope. Please examine his cardiovascular system
- MI > 4 weeks ago (NYHA no worse than class III)
⚬ LVEF < 35% and non‐sustained VT and positive EP study or
⚬ LVEF < 30% and QRSd ≥ 120 milliseconds - Familial condition with high‐risk SCD
⚬ LQTS, ARVD, Brugada, HCM, complex congenital heart disease
Discussion - Nice Guidance
What Secondary prevention (without other treatable cause) do you recommend for Implantable devices?
Implantable devices
This patient has had syncope. Please examine his cardiovascular system
- cardiac arrest due to VT or VF or
- haemodynamically compromising VT or
- VT with LVEF < 35% (not NYHA IV
Discussion - Nice Guidance
What isCardiac resynchronization therapy (CRT) – biventricular
pacemakers (BiV) for Implantable devices?
Implantable devices
This patient has had syncope. Please examine his cardiovascular system
Extra LV pacemaker lead via the coronary sinus – improves mortality/symptoms
May be considered if:
* LVEF < 35%
* NYHA II–IV on optimal medical therapy
* Sinus rhythm and QRSd > 150 milliseconds (if LBBB morphology may be >120 milliseconds)
