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Practical Management of the Remote Device Clinic

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26 a Multiple shocks could demonstrate clinical deterioration or be ineffective. Managing Alerts Figure 7. Red and Yellow Alerts for PMs and ICDs Red (critical) alerts ICD Alerts Device Integrity Alerts Device • Ventricular fibrillation (VF) detection therapy off • End of service/low battery voltage • Device reset/safety mode • Long charge time Lead • Shock impedance out of range • RV pacing impedance out of range • Noise episode Clinical Alerts Therapy • Multiple shocks (≥2) delivered a Red (critical) alerts Pacemaker Alerts Device Integrity Alerts Device • In PM-dependent patients: ▶ Low battery voltage ▶ Device reset or in safety mode Lead • In PM-dependent patients: ▶ RV pacing impedance out of range ▶ Noise episode Clinical Alerts None Red (critical) alerts ILR Alerts Device Integrity Alerts None Clinical Alerts Bradycardia • HR ≤ 30 beats per minute (bpm) (with complete heart block) • Asystole/pause ≥ 6 seconds Tachycardia • 30 beats > 231 bpm Arrhythmias • AF > 6 minutes in cryptogenic stroke patients

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