Perform an emergency evaluation if:
(1) the ICD has delivered multiple shocks
(2) there has been a change in the patient's status (exacerbation of heart failure, chest pain, other)
Otherwise a visit with an electrophysiologist is scheduled for the next week.
Questions for evaluation:
(1) Did the patient have an electrical storm?
(2) Was the ICD shock delivery appropriate?
(3) Is there a reversible cause for ventricular arrhythmia (ischemia, electrolyte imbalance, other)?
Electrical storm present:
(1) administer an antiarrhythmic agent such as amiodarone
(2) evaluate for and treat reversible causes of ventricular arrhythmia
(3) optimize program for antitachycardia pacing
(4) for refractory ventricular tachycardia consider intubation, ablation, left ventricular assist device or cardiac transplantation
(5) consider administration of an anxiolytic
(6) address the patient's quality of life
ICD shock delivery appropriate:
(1) evaluate for and treat reversible causes of ventricular arrhythmia
(2) optimize program for antitachycardia pacing
(3) consider administering an antiarrhytmic agent such as amiodarone
(4) address the patient's quality of life
ICD shock delivery inappropriate:
(1) optimize the discriminatory programming for the ICD
(2) evaluate for and treat supraventricular tachycardia
(3) evaluate the patient for lead oversensing
(4) address the patient's quality of life
