With more and more folks walking around with AICDs this complaint is not unusual anymore. For isolated occurrences without significant change in clinical status patients can go on about their business and see their EP in clinic in a day or so (although you’ll want to give the EP a call and let him/her know what’s going on). Other situations, such as electrical storm or repeated inappropriate discharges, are dire emergencies. You, the front line provider, will have to initiate action while waiting for the cardiologist to arrive. It usually falls on the ER physician. Because hospitalists are liable to get in the loop somewhere I thought it was worthwhile linking here. You need to have a systematic approach in mind. Your best friends in such an emergency (when used properly!) are amiodarone, beta blockers, a magnet, and the device company representative.
A JAMA article form 2006, available as free full text, provides clear explanations and an algorithm, and this recent piece from Emergency Medicine News discusses the approach from the perspective of the ER physician.
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