Frequent Therapies

Episodes of ventricular tachyarrhythmias sometimes come in storms or bunches. Antitachycardia pacing can reduce the frequency of shocks, but usually antiarrhythmic medications such as amiodarone are required to reduce the frequency of therapy (13). Sotalol has also been shown to be effective in reducing the frequency of shocks in ICD patients (14). In addition, VT ablation, particularly the ablation of bundle-branch reentry VT, can be a useful adjunct. It is important to understand that amiodarone and VT ablation do not prolong life, and that their use is only adjunctive to ICD therapy.

ELECTROMAGNETIC INTERFERENCE (EMI)

Patients should be counseled to avoid sources of EMI, because it may cause the pulse generator to become inhibited, fail to deliver appropriate therapy, or deliver inappropriate therapy. Potential sources of EMI include industrial transformers, radio-frequency transmitters such as RADAR, therapeutic diathermy equipment, arc welding equipment, toy radiotransmitters, anti-theft devices such as electronic article surveillance systems, and magnetic wands. The safe use of medical technologies such as electrosur-gery, lithotripsy, external defibrillation, and ionizing radiation can be accomplished by deactivating the device prior to the event. Shielding the device is also appropriate when possible. The device should be evaluated for appropriate operation following exposure. Magnetic resonance imaging (MRI) is contraindicated. Recent reports of interference created by cellular phones may be related to either a magnetic field from within the phone or the radiofrequency signal generated by the phone. It is suggested that if an ICD patient wishes to use a cellular phone, it should be held to the ear opposite the device and carried at least 6-12 inches away from the pulse generator (15).

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