Characteristics of patients presenting to the emergency department with ICD shock

Introduction Patients with an ICD device can apply to emergency departments (EDs) with various complaints. In most of these visits, the analysis of the electrical activity of the patient's ICD device is guiding in the management of the patient. However, it is not possible to perform this analysis 24/7 in many EDs. Analysis of the ED visits of patients with ICD can guide physicians for the management of these patients. In this cross-sectional study, we aim to investigate the type of ICD shocks and the factors affecting it in patients admitted to the ED with ICD shock. Materials and Methods This study reviewed visits of patients with ICD who applied to the ED with cardiac complaints such as ICD shock, palpitation, syncope, and chest- pain, and underwent ICD analysis in Dokuz Eylul University Hospital ED from 1st of January 2010 to 1st of May 2021.The patients who did not analyse for ICD shocks for any reason were excluded from the study. The baseline demographic, laboratory data, treatments applied, ECG findings and patients' outcomes were obtained from the hospital information management system. Cardiology consultations were reviewed for the results of analyzes of ICDs. The details of electrical activities from ICD interrogation were investigated from cardiology consultation. Results One hundred and eighty-nine visits of 75 patients were included in the study. The median age of the patients was 66 (18 to 89 years), and 80.4% of them were male. We found that 64.2% of the cases were appropriately shocked, 20.8% were inappropriately shocked, and 14.8% were false shocking. 60.1% of admissions with appropriate shocks were applied to VT, 28.1% to VF, and 6.4% to both VT and VF. Inappropriate shocks were most frequently applied to atrial fibrillation (45.7%,), supraventricular tachycardia (31.4%), atrial tachycardia (5.7%), and sinus tachycardia (2.8%.), respectively. We found that the inappropriate shocking was more common in females and without a history of shock, and lower in patients with coronary heart disease. On the other hand, we found that the use of antiaggregant agents was more frequent, the QT duration was longer, and the CRP value was lower in cases with appropriate shock. False shocking was more common in women, but less common in diabetic and hypertensive patients. The mean age of patients who underwent false shock was higher. Conclusion We found that more than one-third of the patients who presented to our ED with the possibility of ICD shock had inappropriate or false shock. Inappropriate shocking was more common in females and those without a previous shock history, and lower in patients with coronary heart disease. We found that antiaggregant agent usage was more frequent, QT duration was longer, and CRP value was lower in cases with appropriate shock. While false shock was more common in women, it was less common in diabetic and hypertensive patients. The mean age of the patients who underwent false shock was higher.