Stimulateurs cardiaques et défibrillateurs automatiques implantés : connaissances basiques pour le réanimateur

Indications for pacemakers and implantable cardioverter defibrillators get more and more frequent with results of clinical trials. Basic knowledge about these devices is therefore needed by ICU physicians in order to optimise patients' treatments. Several cases of malfunctioning may occur with pacemakers and defibrillators such as empty batteries, faulty programming, increase of stimulation or defibrillation thresholds. It is necessary to obtain clinical data and technical specifications of the devices, mentioned on the card delivered to the patient, in order to analyse the cause of malfunctioning. The functioning of the pacemaker is to be analysed by the use of a magnet while performing an ECG. The analysis of the defibrillator's functioning requires a specialist. However, the physician must be able to determine if the therapy delivered is appropriate or not. A defibrillator, which delivers inappropriate therapy can be inhibited by a magnet. Any electromagnetic interference may entail deprogramming or even fatal failure of the implanted device; therefore patients require extensive supervision when exposed to them. Other complications such as infection or leads migration also require specific treatment.