Device care continues after implantation
Confirm the device type, implant date, manufacturer, and responsible device clinic. Ensure the patient knows how to contact that team and carries a device identification card.[3]
Interrogation reviews battery status, lead function, sensing/capture, pacing burden, and recorded rhythms or therapies. Follow-up may combine remote transmissions and in-person assessments according to device and patient needs.[1]
01 · DEVICE
Records information
The implanted system stores rhythm and device data.
02 · CONNECTION
Sends a transmission
A compatible home monitor or phone app transfers data when connected.
03 · DEVICE CLINIC
Reviews and responds
The team assesses alerts and arranges clinical follow-up.
Remote monitoring is not an emergency service.Transmission and review may not be immediate. Patients with emergency symptoms should call 911 rather than wait for an alert response.[1]
What to do after an ICD shock
One shock, then feels well
Sit down, contact the device clinic promptly—ideally the same day—and follow its shock plan. Send a remote transmission if instructed. If the team cannot be reached, obtain urgent medical advice.
A shock with syncope, chest pain, severe breathlessness, or persistent illness
Call 911. Do not drive to the hospital.
Repeated shocks—such as two or more within 24 hours
Call 911 for emergency assessment, even if the patient feels better between shocks.
[2]
Document the time, number of shocks, symptoms, and circumstances. Device interrogation determines whether treatment was appropriate and helps identify the rhythm or a sensing/lead issue. A shock can be lifesaving, but still needs review.
After a shock, pause driving until the treating team gives a specific plan. The restriction depends on the event, indication, and applicable rules. Address fear or anxiety after shocks as part of follow-up.[3]
Recognize warning signs
Pocket redness, warmth, drainage, increasing swelling/pain, wound opening, or exposed hardware
Urgent device/EP evaluation for possible infection. Fever, systemic illness, or instability warrants emergency assessment.
New syncope, marked dizziness, severe breathlessness, or chest pain
Assess urgently; emergency symptoms require EMS. A device does not exclude another serious cardiac cause.
Device beep/vibration alert, persistent hiccups, or muscle twitching
Contact the device clinic promptly for interrogation. Symptoms and stability determine urgency.
Lost monitor connection or missed transmissions
Reconnect with help from the device clinic; confirm that monitoring has resumed.
[1], [2], [4]
Possible device infection is not routine wound follow-up.Pocket infection or erosion may require specialist assessment of the entire system, including extraction. Do not delay referral while treating it as a simple skin infection.[4]
Coordinate procedures and everyday care
- MRI or surgery: inform the procedural team and device clinic in advance. Device/lead details, pacing dependence, and the procedure determine the programming and monitoring plan.
- Magnets and electronics: keep strong magnets and phones at least six inches from the implant; avoid carrying a phone directly over the generator. Follow manufacturer guidance for specific equipment.
- Recovery: reinforce the implanting team’s wound care and activity restrictions rather than giving one rule for every device.[2], [3], [5]
Keep treating the underlying heart disease
Continue prescribed heart failure and arrhythmia treatment. A device does not replace medication, stroke-risk assessment for coexisting AFib, or evaluation of new symptoms.[3]
For CRT patients, worsening heart failure should prompt review of clinical status, treatment, and effective resynchronization delivery. AF, ventricular ectopy, lead problems, or programming may reduce effective pacing and require specialist adjustment.[6]
At every visit: confirm the responsible device clinic, monitoring connection, follow-up plan, and the patient’s understanding of what to do after a shock or warning symptom.