›If ventricular fibrillation or pulseless ventricular tachycardia, defibrillation
›If electrical storm with stability, antiarrhythmic infusion protocol dependent
›If recurrent shocks with distress and suspected inappropriate therapy, consider magnet to suspend tachy therapies with continuous monitoring and urgent cardiology involvement
Pacemaker malfunction management
›Pacemaker malfunction plan
›If symptomatic bradycardia with capture failure, transcutaneous pacing and escalation
›If pacer dependent and suspected malfunction, urgent device interrogation and cardiology
›Correct reversible causes including electrolytes and ischemia
›Avoid external electrical interference sources when identified
Pocket hematoma and bleeding
›Pocket bleeding plan
›Analgesia and local measures
›Anticoagulation management local protocol dependent
›Appropriate ICD shocks for ventricular arrhythmia
›New device malfunction affecting safety
›Pacer dependency with any suspicion of malfunction
›Suspected device infection
›Syncope with high risk ECG findings
Observation pathway criteria
›Observation criteria
›Stable single shock with unclear appropriateness pending interrogation
›Stable palpitations with device and need for telemetry correlation
›Syncope with intermediate risk features and planned urgent interrogation
Discharge criteria
›Discharge criteria
›Stable vitals with reassuring evaluation
›Device interrogation reassuring with clear explanation of symptoms
›No concerning pocket findings
›Reliable rapid follow up with device clinic
Follow up timing
›Follow up plan
›Device clinic follow up within 24 to 72 hours for recent shock or alerts
›Cardiology follow up within 1 week for medication changes
›Primary care follow up for contributing factors
18Discharge Instructions/di7
Copy discharge instructions
›Discharge text
›You were evaluated for symptoms in the setting of an implanted cardiac device
›Return immediately for fainting, chest pain, trouble breathing, repeated shocks, fever, or worsening pocket redness or drainage
›Avoid strong electromagnetic sources near your device and keep phones and magnets away from the implant site
›Take your medications as prescribed and do not stop heart rhythm medicines without medical advice
›Arrange urgent follow up with your device clinic as directed
›If you received an ICD shock today, do not drive until cleared by your clinician local protocol dependent
19References/r7
Guidelines and key sources
›Reference list
›AHA Guidelines for CPR and ECC 2020
›ESC Guidelines on cardiac pacing and cardiac resynchronization therapy 2021
›HRS Expert Consensus Statement on cardiovascular implantable electronic device lead management and extraction 2017
›MADIT II trial 2002
›SCD HeFT trial 2005
›Project instructions
Evidence & Review
Reviewed by SymptomDx Medical Team·Last reviewed
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.