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This transmission shows an R.R.T. (Recommended Replacement Time) alert meaning it’s time to plan the device replacement. This is where remote monitoring may significantly decrease the amount of in-clinical visits. There is no more need to see patients more often when the battery shows a limited remaining duration. When the alert is received, the patient may be electively planned for a generator change, leaving ample time for additional investigation (such as echocardiography) when needed.

In this transmission however, there is also an abnormal real time EGM which shows non-physiological artifacts on the ventricular channel. This is not an alert as lead sensing, thereshold and impedance measurements are all normal. But ICD lead dysfunction may be dangerous as it is associated with inappropriate shocks and loss of capture.

Next steps

This patient was admitted to the hospital soon after the transmission as there was not only indication of a generator change, but also of lead revision. During interrogation, multiple “NSVT” episodes showed signs of RV lead dysfunction with oversensing of noise artifacts. Therefore the patient underwent not only generator change, but also addition of an RV ICD lead.