Description of Event or Problem · 1
THIS PATIENT HAS A BIVENTRICULAR ICD. THE DEVICE NURSES OBTAIN HOME MONITORING DATA PERIODICALLY ON THIS PATIENT. LAST MONTH, THE NP NOTICED THAT HIS BIVENTRICULAR ICD WAS NOT DISCHARGING THERAPIES AT APPROPRIATE TIMES AND REQUESTED THAT HE COME TO CLINIC TO HAVE THE STABILITY RESET SETTING TURNED OFF BECAUSE IT APPEARED TO BE INHIBITING THE THERAPIES. WHEN THE PATIENT CAME TO CLINIC ONE WEEK AGO, THE FELLOW THAT EVALUATED THE PATIENT RECALLED THAT THE STABILITY SETTINGS WERE TURNED ON IN THE FIRST PLACE BECAUSE HE WAS BEING SHOCKED INAPPROPRIATELY AND DECIDED NOT TO TURN OFF THE STABILITY SETTINGS. WE LEARNED THAT THE PATIENT DIED OF VT AT HOME TODAY. WE OBTAINED A HOME MONITORING THAT CAPTURED THE INCIDENT AND FOUND THAT THE DEVICE DID NOT SHOCK THE PATIENT UNTIL 4 MINUTES AFTER THE ONSET OF VT, AND DID NOT SHOCK AGAIN AFTER THE PATIENT WAS STILL IN VT. IT'S THE NP'S OPINION THAT THE PATIENT WOULD HAVE BEEN SHOCKED SOONER IF THE STABILITY SETTING WAS STILL ON. THE PHYSICIAN ISN'T SURE WHY THE STABILITY SETTING WOULD INHIBIT THE PROPER THERAPY AND IS MEETING WITH MEDTRONIC TO REVIEW THE DATA. THE BOTTOM LINE IS THAT IT'S UNCLEAR IF THE DEVICE OR THE SETTINGS PROGRAMMED TO THE DEVICE WAS/WERE DEFECTIVE OR IF HIS UNDERLYING COMPLICATED HEART CONDITION CONTRIBUTED TO THE PATHOLOGY MAKING IT AN IMPOSSIBLE SITUATION TO CORRECT.