CORRESPONDENCE: LETTERS TO THE EDITOR
Patient alert and cardiac defibrillators: Reply
Ruediger Becker, MD* and
Wolfgang Schoels, MD
* University of Heidelberg/Cardiology, Bergheimer Strasse 58, 69115 Heidelberg, Germany (Email: ruediger_becker{at}med.uni-heidelberg.de).
In their Letter to the Editor, Auer and colleagues reported the case of an implantable cardioverter-defibrillator (ICD) patient with suspected tinnitus who presented to an ear-nose-throat (ENT) specialist. Although unaware of the patient-alert feature, the ENT doctor suspected an external sound rather than tinnitus and referred the patient to the cardiologist, who checked the patient's defibrillator and found that an increase in lead impedance had triggered the patient-alert function. The impedance rise obviously reflected severe lead dysfunction requiring immediate surgical revision. The investigators conclude that training and education about various ICD features including patient alert should be provided to both patients and physicians. We believe that educating the entire medical community to various ICD features is hardly feasible, but undoubtedly it makes no sense to activate features such as patient alert without educating the patients. During routine postimplant ICD programming, the alert signal should be demonstrated to the patient (as available via programmer telemetry) and the alert time should be discussed and individually adapted to the patient's waking hours. If this becomes part of the clinical routine, as in our center, the patient-alert feature may well be a useful additional tool that facilitates early detection of system-related complications (1). Moreover, even in the case presented by Auer and colleagues, the alert feature served to disclose a severe lead complication that otherwise would have been diagnosed only at the next routine follow-up visit.
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1. Becker R, Ruf-Richter J, Senges-Becker JC, et al. Patient alert in implantable cardioverter-defibrillators: toy or tool? J Am Coll Cardiol 2004;44:95-98.[Abstract/Free Full Text]
Related Article
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Patient alert and cardiac defibrillators
- Johann Auer, Robert Berent, and Bernd Eber
J. Am. Coll. Cardiol. 2005 45: 966.
[Full Text]
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