@article {Sandgrene000249, author = {Emma Sandgren and Cecilia Rorsman and Johan Engdahl and Nils Edvardsson}, title = {Low rate of and rapid attention to inappropriate ICD shocks with remote device and rhythm monitoring: a qualitative study}, volume = {2}, number = {1}, elocation-id = {e000249}, year = {2015}, doi = {10.1136/openhrt-2015-000249}, publisher = {Archives of Disease in childhood}, abstract = {Objectives 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.Methods 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.Results 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.Conclusions 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.}, URL = {https://openheart.bmj.com/content/2/1/e000249}, eprint = {https://openheart.bmj.com/content/2/1/e000249.full.pdf}, journal = {Open Heart} }