Chapter 5 · Remote monitoring · Transmission 7
R.R.T.
You receive the following transmission:
Your turn
What is the correct answer ?
- Plan for generator change
- Plan for generator change and addition of atrial lead
- Plan for generator change and addition of right ventricular lead
- Plan for generator change and addition of left ventricular lead
Explications
This transmission shows an R.R.T. (Recommended Replacement Time) alert meaning it’s time to plan the device replacement. This is where remote monitoring may significantly decrease the amount of in-clinical visits. There is no more need to see patients more often when the battery shows a limited remaining duration. When the alert is received, the patient may be electively planned for a generator change, leaving ample time for additional investigation (such as echocardiography) when needed.
In this transmission however, there is also an abnormal real time EGM which shows non-physiological artifacts on the ventricular channel. This is not an alert as lead sensing, threshold and impedance measurements are all normal. But ICD lead dysfunction may be dangerous as it is associated with inappropriate shocks and loss of capture.
Next steps
This patient was admitted to the hospital soon after the transmission; as there was not only indication of a generator change, but also of lead revision. During interrogation, multiple “NSVT” episodes showed signs of RV lead dysfunction with oversensing of noise artifacts. Therefore the patient underwent not only generator change, but also addition of an RV ICD lead.
Practice out loud
Just describe the tracing. What do you think is going on? Describing the numbers can help.
—
From Implantable Cardioverter Defibrillator — Clinical cases from patients with MicroPort™ ICDs by M. Strik, A. Thiyagarajah, S. Ploux, P. Bordachar, P. Ritter. Published by Cardiocases. Each case is a question on real device interrogations: pick your answer, check it, then read the authors’ interpretation. Tap any figure to open it full screen.