title: Low rate of and rapid attention to inappropriate ICD shocks with remote device and rhythm monitoring: a qualitative study.
abstract: Inappropriate shocks are unpleasant and painful. We hypothesise that remote monitoring and careful attention to known and incident atrial fibrillation (AF) can reduce inappropriate shocks to a very low level in clinical praxis.
  
  
  
  Altogether 259 patients with implantable cardioverter defibrillator implanted for secondary (S, n=113) and primary (P, n=146) prevention were followed via remote monitoring. At implant, 42S (37%) and 54P (37%) patients had known AF.
  
  
  
  Inappropriate shocks, all but five due to AF, occurred in 7S (6.2%) and 11P (7.5%), and there were only inappropriate shocks in 5/7S and in 8/11P. They occurred in four of 42S (9.5%) with and in three of 71S (4.2%) without known AF, and in seven of 54P (13%) with and in four of 92P (4.3%) without known AF. The median time from shock to action was 5 and 1 day, respectively. Actions were medication with amiodarone, β blockers, β blockers+amiodarone or β blockers+digoxin (n=5), β blockers+insertion of an atrial lead (n=1), replacement of a fractured lead (n=2), reprogramming in combination with β blockers, digoxin or amiodarone (n=4), reprogramming (n=2) and none (n=4). After action, four further inappropriate shocks occurred during more than 2 years of follow-up, all due to AF.
  
  
  
  Inappropriate shocks occurred at a low rate and most often because of AF known at implant. Remote monitoring enabled rapid action, after which few inappropriate shocks occurred over more than 2 years. Attention to known and incident AF was the most important action to reduce inappropriate shocks.
authors.affiliation: Department of Medicine , Halland Hospital , Varberg , Sweden.
authors.forename: Emma
authors.initials: E
authors.lastname: Sandgren
authors.affiliation: Department of Medicine , Halland Hospital , Varberg , Sweden.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Rorsman
authors.affiliation: Department of Medicine , Halland Hospital , Halmstad , Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Engdahl
authors.affiliation: Sahlgrenska Academy , Sahlgrenska University Hospital , Göteborg , Sweden.
authors.forename: Nils
authors.initials: N
authors.lastname: Edvardsson