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Device Management

Practical guide to cardiac implantable electronic devices (CIEDs) for cardiology APPs and clinic nurses. Covers PPM, ICD, CRT, and loop recorder indications, EGM interpretation, Biotronik-specific features, remote monitoring review, and patient education.

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🔋Device Management

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Pre-Test — Device Management

~2 min

Answer a few quick questions before starting to measure your learning gain.

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Overview

Learning Objectives

1.Identify device types and their indications (PPM, ICD, CRT-P, CRT-D, S-ICD, ILR)
2.Apply 2018 ACC/AHA and 2023 HRS pacemaker guidelines
3.Apply ICD primary and secondary prevention indications
4.Interpret EGM markers (AS, AP, VS, VP, TS, TF, TD, CD)
5.Identify red-flag remote monitoring findings requiring provider escalation
6.Understand Biotronik-specific features: SafeR, Home Monitoring, SMART detection
7.Educate patients on device living, activity restrictions, and when to seek emergency care

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APP Lesson: Device Management Foundations

Audience: Cardiology APPs and nurses in an interventional cardiology clinic implanting PPMs, ICDs, CRT devices, and loop recorders. Primary vendor: Biotronik. Secondary: Medtronic.

Section 1: Device Types Overview

›Cardiac implantable electronic devices (CIEDs) span a spectrum from simple rhythm monitors to complex resynchronization-defibrillators. Understanding what each device can and cannot do is foundational to clinic work.
›— PERMANENT PACEMAKERS (PPM) —
›Indication categories: sinus node dysfunction (SND), AV conduction disease, cardiac resynchronization (CRT-P), and congenital/structural disease.
›Chamber configurations: single-chamber (AAI paces/senses atrium only; VVI paces/senses ventricle only), dual-chamber (DDD senses and paces both chambers), CRT-P (biventricular — adds left ventricular lead for resynchronization).
›Lead types: transvenous endocardial leads (standard), epicardial leads (surgical approach when venous access is unavailable), leadless intracardiac pacemakers (no transvenous lead).
›Biotronik PPM lines: Edora (standard dual-chamber), Eluna (advanced — SafeR mode, Home Monitoring, ProMRI), Entovis (entry-level single or dual chamber), Rivacor (CRT-P biventricular).
›Leadless pacemakers: Micra (Medtronic) and Aveir (Abbott) — single-chamber RV delivery. Emerging dual-chamber and LV-only leadless systems are in development and early clinical use.
›— ICDs —
›Transvenous ICD: single-coil vs dual-coil high-voltage lead; single-chamber (VVI-ICD) or dual-chamber (DDD-ICD) pacing capability.
›CRT-D: biventricular pacing plus defibrillation — for patients who need both resynchronization and ICD therapy.
›Subcutaneous ICD (S-ICD): no transvenous leads, delivers defibrillation only. No bradycardia pacing, no ATP capability. Ideal for younger patients, prior device infection, or no pacing need.
›Biotronik ICD lines: Acticor (single-chamber VR ICD), Inlexa (dual-chamber), Rivacor (CRT-D), Ilivia (CRT-D, advanced features).
›— CARDIAC RESYNCHRONIZATION THERAPY (CRT) —
›CRT-P: biventricular pacing only — no defibrillation. Used when resynchronization is needed but ICD is not indicated (e.g., frailty, advanced CKD, NYHA IV with poor prognosis).
›CRT-D: biventricular pacing plus ICD — used when both are indicated. Most HFrEF patients with EF ≤35% qualify for the CRT-D over CRT-P.
›Goal: synchronize LV and RV contraction by pacing both ventricles simultaneously, improving cardiac output and reducing dyssynchrony.
›— IMPLANTABLE LOOP RECORDERS (ILR) —
›Biotronik BioMonitor 3: subcutaneous, continuous ECG monitoring up to 4+ years. Minimally invasive implant.
›Indications: unexplained syncope, cryptogenic stroke workup (AF detection), suspected paroxysmal AFib, palpitations with infrequent episodes not captured on shorter monitors.
›Auto-detects: bradycardia, tachycardia, pauses, AFib, and patient-triggered events via a handheld activator.

Section 2: Pacemaker Indications (2018 ACC/AHA + 2023 HRS Updates)

›— SINUS NODE DYSFUNCTION (SND) —
›Class I: Symptomatic bradycardia (fatigue, presyncope, syncope, exertional limitation) due to SND.
›Class I: Sinus pauses causing symptoms.
›Class I: Chronotropic incompetence causing symptoms (heart rate fails to increase appropriately with exertion).
›Class I: SND caused by required drug therapy with no acceptable alternative (e.g., AV nodal agents needed for other arrhythmias).
›Class IIa: SND with resting HR <40 bpm even without clearly documented symptom correlation.
›— AV BLOCK —
›Class I: Third-degree (complete) AV block — regardless of symptoms, site, or ventricular rate.
›Class I: Second-degree Mobitz II AV block — regardless of symptoms. Block is at or below bundle of His; unpredictable progression to complete block.
›Class I: High-degree AV block (2:1 or greater conduction ratio causing hemodynamic compromise or symptoms).
›Class I: Symptomatic second-degree Mobitz I (Wenckebach) — less common indication; only when truly symptomatic.
›Class IIa: Asymptomatic Mobitz II at bundle branch level (infranodal block on EP study).
›Class I: Bifascicular block with syncope and suspected AV block as cause.
›Class I: LBBB post-TAVR with development of high-degree or complete AV block.
›— PACING TO PREVENT TACHYCARDIA —
›Class IIa: Recurrent pause-dependent VT (long QT with pause-triggered torsades, or long-short sequence-initiated VT) — overdrive pacing to suppress.
›— 2023 HRS PHYSIOLOGIC PACING UPDATES —
›Conduction system pacing (CSP): His-bundle pacing (HBP) and Left Bundle Branch Area Pacing (LBBAP) are preferred over traditional RV apical pacing when high RV pacing burden is expected — preserves natural ventricular conduction.
›LBBAP: Class I when CRT is indicated but coronary sinus (CS) lead implant fails. Class IIa for high-degree AV pacing requirement with EF ≤50%.
›Avoid unnecessary RV pacing: SafeR mode (Biotronik) and AAI-DDD auto-switching algorithms minimize RV pacing burden. High RV pacing burden can induce dyssynchrony and LV dysfunction.

Section 3: ICD Indications (2025 AUC + 2022 AHA HF Guidelines)

›— SECONDARY PREVENTION (prior VT/VF) —
›Class I: Survivors of cardiac arrest from VF or hemodynamically unstable sustained VT not due to a fully reversible cause (e.g., acute ischemia, electrolyte emergency).
›Class I: Sustained VT with structural heart disease — even if hemodynamically tolerated.
›Class I: Syncope of unknown cause with inducible sustained VT or VF on electrophysiology study (EPS).
›— PRIMARY PREVENTION — HFrEF —
›Class I: LVEF ≤35%, NYHA class II–III HF symptoms, on optimized GDMT for ≥3 months, ischemic or non-ischemic cardiomyopathy, life expectancy >1 year with good functional status.
›Class I: LVEF ≤30%, NYHA class I, ischemic cardiomyopathy, ≥40 days post-MI.
›Critical timing: Do NOT implant within 40 days of acute MI or within 90 days of coronary revascularization. Allow EF reassessment — GDMT often recovers EF significantly.
›GDMT optimization before ICD decision: sacubitril/valsartan, beta-blocker, mineralocorticoid receptor antagonist (MRA), SGLT2 inhibitor. All four pillars should be maximized before ICD assessment.
›2024 evolving evidence: growing data on GDMT improving or normalizing EF such that ICD benefit is reduced or eliminated. Provider judgment and shared decision-making are critical.
›— PRIMARY PREVENTION — CHANNELOPATHIES / INHERITED DISEASE —
›Brugada syndrome, Long QT syndrome, Hypertrophic Cardiomyopathy (HCM) with high-risk features, ARVC — ICD decisions per specialty guidelines with electrophysiology input.
›— SUBCUTANEOUS ICD (S-ICD) SELECTION —
›Appropriate when: no pacing requirement (no SND, no AV block, no ATP need for VT, no CRT indication), adequate R-wave amplitude on sensing screen, young patient (reducing long-term hardware burden), prior device infection.
›Not appropriate when: bradycardia pacing needed, ATP for VT is a likely requirement, CRT is needed, or sensing screen fails.
›Pre-implant sensing screen required: assess R-wave/T-wave ratio in multiple vectors — T-wave oversensing is the primary cause of inappropriate S-ICD shocks.

Section 4: CRT Indications (2022 AHA HF + 2023 HRS Physiologic Pacing)

›— CLASS I —
›LVEF ≤35%, LBBB morphology, QRS ≥150ms, NYHA II–IV on GDMT — strongest evidence base for CRT benefit.
›LVEF ≤35%, LBBB, QRS 120–149ms — Class I with updated evidence, particularly in women (women may benefit at shorter QRS durations).
›High-degree AV block with LVEF ≤35% requiring ventricular pacing — prefer CRT-D/CRT-P over right ventricular pacing alone to prevent pacing-induced cardiomyopathy.
›— CLASS IIa —
›LVEF ≤35%, non-LBBB morphology (RBBB, IVCD), QRS ≥150ms, NYHA III–IV — benefit is reduced but may still be meaningful.
›LVEF 36–50% with high RV pacing burden (>40%) and evidence of EF decline attributed to RV pacing — upgrade to CRT.
›— CRT-D vs CRT-P SELECTION —
›CRT-D: when ICD indication is also present — this is most HFrEF patients with EF ≤35% and adequate life expectancy.
›CRT-P: when ICD indication is absent — NYHA IV with very poor prognosis and limited life expectancy, advanced CKD (stage 5), significant frailty, or patient preference after shared decision-making.

Section 5: EGM Reading — Practical Guide

›— KEY MARKER TERMINOLOGY —
›AS: Atrial Sense — intrinsic P-wave detected by atrial lead.
›AP: Atrial Pace — device delivers an atrial pacing stimulus.
›VS: Ventricular Sense — intrinsic R-wave detected by ventricular lead.
›VP: Ventricular Pace — device delivers a ventricular pacing stimulus.
›AR: Atrial Refractory Sense — P-wave sensed during atrial refractory period; not tracked to ventricle.
›VR: Ventricular Refractory Sense — event sensed during ventricular refractory period; not counted as a beat.
›TS: Tachycardia Sense — event falling in the VT detection rate zone.
›TF: Tachycardia Sense in Fast VT or VF zone.
›TD: Tachycardia Detection — detection criteria met (rate + duration); therapy preparing.
›CD: Charge Delivered — shock therapy marker; confirms shock was delivered.
›— KEY INTERVALS —
›AV delay (AVD): time from AP or AS to VP — typically programmed 120–200ms. Longer AVD allows intrinsic AV conduction (reduces VP%). Shorter AVD ensures CRT synchrony in CRT devices.
›PVARP (Post-Ventricular Atrial Refractory Period): atrial channel is refractory after each VP — prevents sensing retrograde P-waves (avoiding pacemaker-mediated tachycardia, PMT). Too short = PMT risk; too long = limits upper tracking rate.
›TARP (Total Atrial Refractory Period) = AV delay + PVARP. Determines the upper tracking rate limit: 60,000 ÷ TARP (ms) = maximum tracked rate.
›Upper Tracking Rate (UTR): fastest ventricular pacing rate in DDD tracking mode. Typically 130–150 bpm for most clinic patients.
›Lower Rate Interval (LRI): minimum pacing cycle length — sets the lowest pacing rate (rest rate). Typically 50–60 bpm.
›Rate Response (DDDR, VVIR): sensor-driven rate increase with activity. Accelerometer (motion) or minute ventilation sensor. Important for chronotropically incompetent patients.
›— BIOTRONIK-SPECIFIC FEATURES —
›SafeR (Selective Atrial pacing Failure Response): proprietary algorithm that operates in AAI mode unless AV block is detected, then switches to DDD temporarily. Dramatically minimizes RV pacing burden — key for EF preservation.
›Home Monitoring: daily automatic wireless transmission of device diagnostics to the Biotronik data center — lead parameters, battery status, events, arrhythmia burden. Alerts notify the clinic proactively. Patient needs transmitter (LINQ-equivalent) at home.
›SMART Detection: Biotronik ICD SVT/VT discrimination algorithm using: Stability (irregular = AFib), Onset (sudden = VT), Morphology (ventricular vs supraventricular), and Atrio-ventricular Multiplicity (AV relationship). Reduces inappropriate shocks.
›ProMRI: most Biotronik CIEDs are MRI-conditional under specific conditions. Document the device model and confirm MRI-conditional status before any MRI is ordered.
›Atrial and ventricular blanking periods: brief post-pace or post-sense windows where the opposite channel sensing is disabled — prevents cross-talk and double-counting.
›— READING A BIOTRONIK REMOTE MONITORING REPORT —
›Lead parameters: atrial amplitude (mV) — normal >2.0 mV; ventricular amplitude (mV) — normal >5.0 mV. Pacing threshold (volts at a given pulse width — safety margin should be 2:1 or greater). Lead impedance — normal range 300–1000 ohms.
›Battery status: Elective Replacement Indicator (ERI) means generator change is needed — plan in advance. End of Service (EOS) means device no longer functioning reliably.
›Pacing percentages: atrial pacing% and ventricular pacing% — changes from baseline prompt investigation (e.g., VP% rising from 5% to 80% suggests new AV block or SafeR algorithm change).
›Mode switch events: AF burden documented as minutes or hours per day in atrial tachycardia/AFib.
›VT/VF events: number of detected episodes, those treated with ATP, those treated with shock, and self-terminated episodes.
›— ICD DETECTION ZONES (BIOTRONIK) —
›Monitor zone: rate-only detection — no therapy delivered. For surveillance of slower arrhythmias.
›VT zone: typically programmed 150–188 bpm. ATP delivered first (burst or ramp), followed by shocks if ATP fails.
›FVT (Fast VT) zone: typically 188–222 bpm. May receive ATP or go directly to shock depending on programming.
›VF zone: typically >222 bpm (cycle length <270ms). Immediate capacitor charging and shock delivery.
›ATP (Anti-Tachycardia Pacing): rapid burst or ramp pacing delivered during VT to overdrive and terminate without shock. Highly effective for monomorphic VT; reduces shock burden significantly.
›— READING A TREATED EPISODE —
›1. Confirm detection: is the event rate truly in the VT/VF zone?
›2. Confirm it is ventricular: AV relationship analysis, morphology change from baseline (ventricular morphology differs from supraventricular).
›3. ATP delivered: did it terminate the arrhythmia? Did it accelerate into a faster VT or VF?
›4. Shock delivered: was it appropriate (confirmed VT/VF) or inappropriate?
›5. Inappropriate shock causes to recognize: AFib with fast ventricular response, T-wave oversensing (especially S-ICD), lead noise from fracture, SVT (sinus tachycardia, atrial flutter, AVNRT), or electromagnetic interference.

Section 6: Basic Programming Concepts

›— PACEMAKER MODES (NBG CODE) —
›AOO/VOO/DOO: asynchronous pacing — device paces at a fixed rate regardless of intrinsic activity. Used in OR (electrosurgery), during MRI in MRI-conditional mode, or in the presence of electromagnetic interference.
›AAI: atrial pacing, atrial sensing, inhibited by intrinsic atrial activity. No ventricular backup. Used when AV conduction is intact (SND only).
›VVI: ventricular pacing, ventricular sensing, inhibited by intrinsic ventricular activity. Single-chamber ventricular pacing. Backup pacing for AFib patients with bradycardia.
›DDD: dual-chamber — senses and paces both atrium and ventricle. Tracks atrial rate to drive VP. Most physiologic dual-chamber mode.
›DDI: dual-chamber, non-tracking — senses both, paces both, but does not track atrial rate to ventricle. Used to prevent rapid ventricular tracking during atrial arrhythmias (or used during mode switch).
›DDDR/VVIR: rate-responsive versions. The R indicates sensor-driven rate adaptation (accelerometer or minute ventilation).
›— COMMON PROGRAMMING ADJUSTMENTS IN CLINIC —
›AV delay: Shorten to ensure CRT biventricular pacing (VP should follow AP/AS immediately). Too long = intrinsic conduction bypasses LV lead and loses resynchronization. Typical CRT AV delay: 80–120ms.
›Lower rate: typically 50–60 bpm at rest. Increase to 70–80 bpm post-ablation for rate support or idioventricular rhythm suppression.
›Upper tracking rate: 130–150 bpm typical. May increase to 160–170 bpm for active patients with chronotropic needs.
›Rate response: enable for chronotropically incompetent patients; adjust sensor sensitivity based on activity level and symptoms.
›Mode switch: enable to automatically switch to DDI or VVIR during AFib/AT to prevent rapid ventricular tracking.
›VT/VF zone rates: adjust detection zones to maintain safety margin above the patient's clinical VT rate (typically ≥20 bpm above documented VT cycle length).
›ATP programming: burst (all coupling intervals equal) vs ramp (coupling intervals decrement by 10–20ms each beat). Ramp may be more effective for faster VT.
›— RED FLAGS FOR PROVIDER REVIEW —
›New VT or VF episodes detected on remote monitoring.
›Inappropriate shock delivered — urgent review of episode EGM.
›Lead impedance out of range: high impedance (>1500–2000 ohms) suggests lead fracture; low impedance (<200–250 ohms) suggests insulation breach.
›Sensing amplitude trending down from baseline — approaching loss of reliable sensing.
›Pacing threshold increasing significantly — risk of capture loss; safety margin compromised.
›Battery at ERI — schedule generator replacement.
›New or significantly increased AFib burden.
›Mode switch frequency increasing — may indicate progression of AF burden.
›VP% changing significantly from baseline without explanation — new AV block or algorithm issue.

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Clinical Cheat Sheet

Device Type Quick Reference

•PPM: bradycardia (SND, AV block) — pacing only, no shock
•ICD (transvenous): VT/VF prevention — pacing + ATP + shock
•S-ICD: VT/VF prevention, no pacing need — shock only, no ATP, no bradycardia pacing
•CRT-P: HF + dyssynchrony, no ICD indication — biventricular pacing only
•CRT-D: HF + dyssynchrony + ICD indication — biventricular pacing + shock
•ILR (BioMonitor 3): monitoring only — continuous ECG, no therapy

ICD Primary Prevention At-a-Glance

•LVEF ≤35% + NYHA II–III + GDMT ≥3 months + life expectancy >1 year → Class I ICD
•LVEF ≤30% + NYHA I + ischemic CM + ≥40 days post-MI → Class I ICD
•Wait: no ICD within 40 days of MI or 90 days of revascularization
•Always optimize GDMT first — EF may recover
•S-ICD if: young patient, no pacing need, no ATP need, no CRT need

CRT Indications At-a-Glance

•LVEF ≤35% + LBBB + QRS ≥150ms + NYHA II–IV → Class I (strongest)
•LVEF ≤35% + LBBB + QRS 120–149ms → Class I
•LVEF ≤35% + non-LBBB + QRS ≥150ms + NYHA III–IV → Class IIa
•High RV pacing burden + EF ≤50% + EF declining → Class IIa CRT upgrade
•CRT-D if ICD also indicated; CRT-P if not (poor prognosis, advanced CKD)

EGM Marker Legend

•AS = Atrial Sense (intrinsic P-wave)
•AP = Atrial Pace (paced atrial beat)
•VS = Ventricular Sense (intrinsic R-wave)
•VP = Ventricular Pace (paced ventricular beat)
•AR = Atrial Refractory Sense (not tracked)
•TS = Tachycardia Sense (in VT zone)
•TF = Tachycardia Sense (in FVT/VF zone)
•TD = Tachycardia Detection (criteria met, therapy initiating)
•CD = Charge Delivered (shock marker)

Normal Lead Parameter Ranges

•Atrial sensing amplitude: >2.0 mV (ideal >3.0 mV)
•Ventricular sensing amplitude: >5.0 mV (ideal >7.0 mV)
•Pacing threshold: <1.5V at 0.4ms; safety margin ≥2:1
•Lead impedance (pacing): 300–1000 ohms
•High impedance (>1500–2000Ω): suspect lead fracture
•Low impedance (<200–250Ω): suspect insulation breach

Battery Status Guide

•BOL (Beginning of Life): full battery — years of service remaining
•MOL (Middle of Life): routine function — normal follow-up
•ERI (Elective Replacement Indicator): plan generator change — typically 3–6 months remaining
•EOS (End of Service): device no longer reliable — urgent replacement

Biotronik ICD Zone Structure

•Monitor zone: rate-only, no therapy — surveillance
•VT zone (~150–188 bpm): ATP first → shocks if ATP fails
•FVT zone (~188–222 bpm): ATP or direct shock per programming
•VF zone (>222 bpm, CL <270ms): immediate charge and shock
•ATP: burst (fixed intervals) or ramp (decrementing intervals)

Red Flags — Escalate to Provider

•New VT or VF episode on remote monitoring
•Shock delivered — review EGM for appropriateness
•Inappropriate shock (AFib, T-wave oversensing, lead noise)
•Lead impedance out of range (high = fracture, low = insulation)
•Sensing amplitude declining toward threshold
•Pacing threshold rising — capture loss risk
•Battery at ERI
•Significant new or increasing AFib burden
•VP% change without explanation
•Wound signs: erythema, drainage, warmth, device erosion

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Device Clinic Checklist

Systematic device clinic assessment for PPM, ICD, CRT, and ILR patients.

Device Identification

Confirm device manufacturer (Biotronik, Medtronic, Abbott/SJM)
Confirm device model and type (PPM, ICD, CRT-P, CRT-D, ILR)
Document implant date and implanting physician
Document indication for implant
Confirm if MRI-conditional (Biotronik ProMRI — document model for MRI orders)
Device card given to patient?

Remote Monitoring

Biotronik Home Monitoring enrollment confirmed?
Patient has transmitter at home and understands nightly transmission?
Last transmission reviewed by clinical team?
Any unreviewed alerts in the Home Monitoring portal?

Lead Parameters

Atrial sensing amplitude in range (>2.0 mV)?
Ventricular sensing amplitude in range (>5.0 mV)?
Pacing thresholds acceptable (safety margin ≥2:1)?
Lead impedances in range (300–1000 ohms)?
Any significant changes from prior visit?

Battery and Device Status

Battery status: BOL / MOL / ERI / EOS?
If at ERI: alert provider and schedule generator replacement
Pacing percentages: atrial and ventricular — compare to baseline
Mode switch events / AFib burden documented?

Arrhythmia Events

VT/VF episodes since last visit?
Shocks delivered — how many, when?
ATP delivered — successful?
If any episode: flag for provider EGM review before patient leaves
Inappropriate shock? Confirm with provider

Wound and Device Site Assessment

Incision healed (recent implant)?
Signs of infection: erythema, warmth, drainage, swelling?
Device erosion through skin?
Pocket hematoma?
Any pain or tenderness at site?

Patient Education and Safety

Magnet use education: ICD patients must know magnet deactivates tachycardia therapy — inform surgeon before procedures
New implant activity restriction: no arm raising above shoulder on implant side for 4–6 weeks
Driving restrictions after ICD: 1 week after elective implant; 6 months after treated VT/VF event (state laws vary)
Airport security: show device ID card, request hand wand, avoid extended exposure to metal detector
MRI instructions: Biotronik ProMRI devices are MRI-conditional — always inform radiology of device before MRI
Emergency instructions given: when to call clinic vs call 911 (single shock → call clinic; multiple shocks or sustained symptoms → call 911)
Remote monitoring education: plug in transmitter nightly, do not unplug or move without asking the clinic

Follow-up Schedule

Post-implant: 2 weeks (wound check, initial device interrogation)
Short-term: 6–8 weeks post-implant (full programming review)
Ongoing: every 3–6 months in clinic or per Home Monitoring schedule
At ERI: return in 1–3 months for generator change planning
As needed: any alert, shock, or patient-reported symptom

📄

Patient Education Handout

What Your Device Does

A pacemaker monitors your heart rate and sends small electrical signals to keep your heart from beating too slowly. It does not shock you.
A defibrillator (ICD) does everything a pacemaker does, and it can also deliver a larger shock if your heart goes into a dangerous fast rhythm. The shock is meant to reset your heart back to a normal rhythm.
A loop recorder is a small monitor placed just under the skin. It records your heart rhythm continuously for several years. It does not pace or shock — it only records.
A CRT device (resynchronization therapy) helps the right and left sides of your heart beat together in sync. This can improve heart function and how you feel day to day.

After Your Implant: What to Expect

You may have soreness and bruising near the device for 1–2 weeks. This is normal.
Keep the incision clean and dry until it heals. Do not submerge it in water (no swimming or tub baths) until cleared by your provider.
Do not lift your arm above shoulder level on the side of the device for 4 to 6 weeks. This protects the leads while they anchor in place.
You may return to most daily activities within a few days, but avoid heavy lifting or strenuous exercise until your provider clears you.
A small lump or ridge under the skin is normal — that is the device.

Daily Life with Your Device

Most household appliances (microwaves, computers, cell phones) are safe. Keep cell phones at least 6 inches away from the device when not in use.
Airport security: always carry your device ID card and tell security staff you have a cardiac device. Request a hand-held wand instead of walking through the metal detector, or pass through quickly — do not linger or lean against it.
MRI scans: most new Biotronik devices are MRI-safe under certain conditions. Always tell the MRI team you have a heart device before your scan.
Magnets: strong magnets (such as those in some headphones, magnetic clasps, or industrial equipment) can temporarily affect your device. Keep strong magnets at least 6 inches away. If a magnet is placed over an ICD, it will temporarily turn off shock therapy.
Heavy electrical equipment (arc welders, large generators): avoid close contact. Standard electrical tools at home are safe.

If Your Device Shocks You

One shock, and you feel fine right away: sit down, rest, and call our clinic. We will review your device transmission.
Multiple shocks in a short time, or you feel dizzy, faint, or have chest pain after a shock: call 911 or go to the emergency room immediately.
A shock means your device detected a dangerous heart rhythm and responded. It does not always mean something is wrong long-term, but it always needs to be reviewed.

Remote Monitoring (Home Monitor)

Your Biotronik Home Monitor transmitter sends your device information to our clinic automatically, usually every night while you sleep.
Keep the transmitter plugged in and within range of your device. Do not unplug or move it without asking us.
You do not need to do anything — it works automatically. If you see a red light or get a notification that a transmission failed, call our clinic.
Remote monitoring lets us check your battery, leads, and any heart rhythm events without you coming in for every small concern.

Battery and Device Life

Pacemakers typically last 7–12 years depending on how much pacing you need.
ICDs (defibrillators) typically last 5–9 years.
When the battery gets low, we will schedule a generator change. This is a minor procedure — the leads usually stay in place and only the generator (the battery/computer part) is replaced.
We track the battery at every visit and remotely. We will give you plenty of notice before it needs to be changed.

When to Call Us vs. When to Call 911

Call our clinic: one shock and feeling fine, device question, wound redness or drainage, device feels like it moved, you are scheduled for a procedure or MRI.
Call 911 / go to the ER: multiple shocks, shock with ongoing chest pain or shortness of breath, fainting, sustained fast or irregular heartbeat that does not resolve, any serious symptoms.
When in doubt, it is always okay to call us first.

This handout is for educational purposes only and does not replace the advice of your healthcare provider. Always follow the specific instructions given to you by your care team.

🗣️

Spanish / Communication Phrases

Interpreter Notice: These phrases are for basic communication and rapport only. Use a certified medical interpreter for diagnosis, treatment decisions, medication changes, consent, discharge instructions, and all complex clinical conversations.

You have a pacemaker / defibrillator implanted in your chest.

Tiene un marcapasos / desfibrilador implantado en el pecho.

Have you received any shocks from your device?

¿Ha recibido alguna descarga de su dispositivo?

It is important to send your device information every night.

Es importante enviar la información de su dispositivo todas las noches.

Do not raise your arm above your shoulder for 4 to 6 weeks.

No levante el brazo por encima del hombro durante 4 a 6 semanas.

Show your device card at the airport and before any MRI.

Muestre su tarjeta de dispositivo en el aeropuerto y antes de cualquier resonancia magnética.

If your device shocks you more than once, go to the emergency room.

Si su dispositivo le da más de una descarga, vaya a la sala de emergencias.

We are checking your device remotely every day.

Estamos revisando su dispositivo de forma remota todos los días.

Your battery is in good condition.

La batería de su dispositivo está en buenas condiciones.

Your device recorded an abnormal heart rhythm.

Su dispositivo registró un ritmo cardíaco anormal.

We need to adjust the settings of your device.

Necesitamos ajustar la configuración de su dispositivo.

Is there any redness, swelling, or drainage near your device?

¿Hay enrojecimiento, hinchazón o secreción cerca de su dispositivo?

Do not use a magnet near your device without asking your doctor.

No use un imán cerca de su dispositivo sin preguntarle a su médico.

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Sim Patient Case

Interventional Cardiology Clinic — Device ClinicInteractive

Patient

[EN] 71-year-old male with ischemic cardiomyopathy, CRT-D (Biotronik Rivacor), on optimized GDMT (sacubitril/valsartan, carvedilol, spironolactone, dapagliflozin). Home Monitoring alert received overnight: 3 VT episodes, 1 terminated by ATP, 2 self-terminated. No shock delivered. [ES] Hombre de 71 años con cardiomiopatía isquémica, CRT-D (Biotronik Rivacor), en terapia médica optimizada. Alerta de monitoreo remoto: 3 episodios de TV, 1 terminado con estimulación antitaquicardia, 2 terminados espontáneamente. No se administró descarga.

Chief Complaint

[EN] "I got a call that my heart device sent an alert last night. I slept through it and feel fine now." [ES] "Me llamaron diciendo que mi dispositivo envió una alerta anoche. Dormí durante todo y ahora me siento bien."

Vitals

118/72 mmHg

68 bpm (paced rhythm)

SpO2

97% on room air

Temp

98.4°F

Weight

182 lb (baseline 180 lb)

Goal

[EN] Identify VT episodes on remote EGM, assess appropriateness of ATP therapy, escalate to provider for medication or programming review, and provide patient education on device alerts and when to seek emergency care. [ES] Identificar los episodios de TV en el electrograma remoto, evaluar la idoneidad de la terapia de estimulación antitaquicardia, escalar al proveedor para revisión de medicamentos o programación, y educar al paciente sobre alertas del dispositivo y cuándo buscar atención de emergencia.

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Knowledge Check Quiz

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