Implantable Cardioverter Defibrillator: clinical cases from patients with Abbott ICDs

Read Abbott ICD tracings with confidence – and program devices that avoid inappropriate and unnecessary shocks. Abbott (formerly St. Jude Medical) implantable cardioverter defibrillators classify cycles, count arrhythmias and confirm shocks differently from other manufacturers. Understanding that logic is what allows you to interpret a stored episode correctly, recognize an inappropriate therapy and choose the right settings. This casebook teaches it the way it is learned in the device clinic: from the tracings themselves. 39 clinical cases and more than 50 annotated EGM tracings recorded on Atlas, Fortify, Unify, Ellipse and the latest Gallant devices. Each tracing is decoded step by step with numbered callouts – markers, counters, charging, confirmation, therapy – and each case ends with the key points to remember and practical programming advice. Why can an irregular VT last more than 20 seconds without completing a single counter? Why does a VS cycle not reset the VT counter? When should the end-of-episode counter be set to 3, and when to 7? The answers are in the tracings. Four chapters: Counters – cycle classification based on the average of 4 intervals, competing VT1, VT2 and VF counters, redetection, the programmable end-of-episode counter, and how the 2015 and 2019 international programming recommendations (high rate cutoffs, 30-interval detection) apply to Abbott devices. Therapies – anti-tachycardia pacing (ATP) during versus before charging in the VF zone, ATP sequences in the VT zone, ATP-induced acceleration, high defibrillation thresholds, shock-induced AF, and the DynamicTx and VF Therapy Assurance (VFTA) algorithms. Discrimination – morphology, stability with sinus interval history and sudden onset in single-chamber devices; V>A, V=A and V Oversensing – lead fracture, T-wave and P-wave oversensing, R-wave double counting, 50 Hz interference and electrocautery, and what the SecureSense™ algorithm can and cannot do. Who is it for? Cardiologists, electrophysiologists and fellows, as well as the nurses, technicians, cardiac physiologists, device specialists and remote monitoring teams who interrogate and program Abbott ICDs and CRT-Ds. About the authors: written by the Stimuprat team – Pierre Bordachar, Marc Strik and Sylvain Ploux, cardiac electrophysiologists at the LIRYC institute in Bordeaux, France.