When is inpatient care indicated for patients with a pacemaker or an implantable cardioverter-defibrillator (ICD)?

Updated: Oct 11, 2019
  • Author: Daniel M Beyerbach, MD, PhD; Chief Editor: Jeffrey N Rottman, MD  more...
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One of the most difficult decisions after a patient presents to the emergency department (ED) complaining of an implantable cardioverter-defibrillator (ICD) discharge is to determine if the discharge was appropriate. Whenever possible, the device should be interrogated, since, unless the shock and the rhythm that preceded it were witnessed, it is not possible to determine shock appropriateness without investigation.

Reasons for admission may include the following:

  • Device investigation - To determine whether there is an imminent battery failure (multiple shocks will deplete battery life)

  • Addition of antiarrhythmic medications

  • Treatment of myocardial infarction (which may be linked to the initial discharge)

  • Treatment of patient discomfort

  • Provision of psychological support - Up to 35% of patients develop anxiety disorder following ICD placement, although disabling problems necessitating admission are fairly uncommon [2]

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