Implantable Cardioverter Defibrillator Therapy

Details

Title

Implantable Cardioverter Defibrillator Therapy

Type

Stage Two

Module code

HPS143

Requirement

Optional

Module objective

By the end of this module the Clinical Scientist in HSST, with respect to implantable cardioverter-defibrillator (ICD) therapy, will be able to critically analyse, synthesise, evaluate and apply knowledge, and lead a pacemaker service, including taking responsibility for the quality assurance and training of other staff, while demonstrating the attitudes and behaviours necessary for the role of a Consultant Clinical Scientist within a patient-focused service

Knowledge and understanding

By the end of this module the Clinical Scientist in HSST will critically analyse, synthesise, evaluate and apply their expert knowledge of ICD therapy, including:

• techniques, modalities, indications, interpretation and the diagnostic yield of non- invasive monitoring techniques such as conventional 12-lead ECG, Holter and event monitoring, implantable loop recorders;
• signal-averaged ECG, heart rate variability, T-wave alternans and ECG-drug infusion tests (ajmaline, adrenalin etc.);
• causes and prevention of stroke; assessment of stroke risk (scoring systems) and anticoagulant therapy; application to the ICD population;
• ensuring the correct patient is selected for implantation;
• the principles of defibrillation and the engineering of device and of defibrillating leads;
• the medical treatment of tachyarrhythmias, including interaction of drugs with defibrillation threshold and arrhythmia cycle length, the pro-arrhythmic effect of antiarrhythmic drugs and their effect on left ventricular function;
• cardiac and thoracic anatomy, especially in respect of venous access, including the cephalic, subclavian and internal jugular vein approach;
• the indications and international and national guidelines for correct ICD implantation;
• management of complications of ICD implantation, including pneumo- haemothorax and lead perforation;
• management of acute complications and during long-term follow-up;
• medico-legal issues concerning consent, provision of information and driving restrictions;
• the evidence base for programming of ICDs following implantation in different patient groups;management of complications of ICD implantation, including pneumo- haemothorax and lead perforation;
• indications, techniques, performance and response interpretation of therapy modalities in heart rhythmology other than ablation.

Technical and clinical skills

By the end of this module the Clinical Scientist in HSST will be able to demonstrate a critical understanding of current research and its application to the performance, adaptation and mastery of a range of clinical and communication skills and will:

• clinically evaluate (history, physical exam) patients with rhythm disorders;
• assess heart failure status and stroke risk;
• integrate the results from different diagnostic techniques into the individual care of patients;
• explain to patients and relatives the potential complications and possible effects on the patient’s lifestyle;
• programme ICDs to maximise therapeutic benefit and minimise complications;
• programme detection and therapy zones with reference to published data;
• programme algorithms for tachycardia discrimination and termination, and for minimising right ventricular pacing;
• manage pacemaker malfunction and troubleshooting;
• assess current drain and battery longevity;
• interpret and assess electrograms, markers, intervals, Holter features, and other storage and diagnosis capabilities;
• implement appropriate programming and/or medical intervention in response to new findings;
• evaluate device diagnostic data in the clinical context and in reference to other non-invasive or invasive techniques;
• reflect on the challenges of applying research to practice in relation to the use of ICD therapy in clinical practice and suggest improvements, building on a critique of available evidence.

Attitudes and behaviours

By the end of this module the Clinical Scientist in HSST will be expected to critically evaluate their own response to both normal and complex situations, consistently demonstrating the professional attributes and insights required of a Clinical Scientist in HSST working within the limits of professional competence, referring as appropriate to senior staff, and will:

• appreciate the importance of and the need to explain lifestyle issues and driving restrictions to the patient;
• be self-confident and recognise limitations;
• commit to the audit of long-term outcomes, including mortality, infection, lead complications, therapy rates and outcomes;
• develop a critical attitude towards a safe preventive programme in the hospital and to support patients in their community with adequate ICD follow-up;
• educate patients about the treatment options following therapy delivery and explain the treatment strategies;
• recognise and remain up to date with developments in the field.