Alert Tones Are Frequently Inaudible among Patients with Implantable Cardioverter‐Defibrillators

Abstract

Background: Current management guidelines for patients with Medtronic Sprint Fidelis ICD leads (Medtronic Inc., Minneapolis, MN, USA) include prominent use of Patient Alert TM , a feature in which the ICD generator emits audible beeps at two programmable frequencies. Because hearing loss is highly prevalent beyond the sixth decade of life, the utility of this feature is unclear. Therefore, we conducted a survey of patients' ability to hear the Medtronic Patient Alert TM . Methods: During visits to an outpatient device clinic, patients with Medtronic ICDs were evaluated for their ability to hear ICD tones. Results: The patient group consisted of 102 patients. Patients older than 70 years comprised 68% of the sample, with 16% between 60 and 70, and 17% younger than 60 years. Of the 102 patients, 59% (56% of males and 70% of females) were able to hear at least one tone. Ability to hear ICD tones decreased with advancing age. Among patients over 60 and 70 years, 52% and 43%, respectively (P < 0.001 vs. patients below 60 and 70 years), could hear at least one tone. Conclusions: The Patient Alert TM feature is not useful among a large proportion of ICD patients. Patients with Sprint Fidelis leads should be evaluated for their ability to hear audible ICD tones. For patients who cannot hear the Patient Alert TM feature, a wireless remote monitoring and/or daily application of a magnet by a caregiver should be considered. Device manufacturers should include nonauditory alert technologies such as wireless remote monitoring and vibratory stimulation in future devices. (PACE 2009; 32:1272-1275

Impact of Implanted Recalled Sprint Fidelis Lead on Patient Mortality

“…However, management must be tailored to patient risk. The Lead Integrity Alert algorithm is limited to patients with Medtronic pulse generators, does not provide advanced warning in approximately 25% of patients, and is limited in part by the inability of older patients to hear alert tones (26). Clinical predictors of lead failure include higher ejection fraction (27), age Ͻ50 years, and, possibly, sports/physical activity (10).…”

Remote Monitoring Reduces Healthcare Use and Improves Quality of Care in Heart Failure Patients With Implantable Defibrillators

“…Indeed, it has been reported that patients frequently do not hear or respond to the audible alert. 23,24 In contrast, in the remote arm, the clinician was automatically notified of the alert condition, and no direct patient interaction was required; this reduced potential patient compliance issues. Data were promptly reviewed, and triage of patients could be performed remotely.…”

Downloadable Software Algorithm Reduces Inappropriate Shocks Caused by Implantable Cardioverter-Defibrillator Lead Fractures

“…We had insufficient data to determine the reasons for delay in each case; however, we are aware of individual cases in which either patients or physicians misinterpreted audible alerts or patients did not hear the alert tone. 26 Use of remote monitoring with wireless-telemetry ICDs permits automatic transmission of LIA notifications and might reduce delays if physicians respond promptly. In the present study, too few patients had automated LIA notifications transmitted by remote monitoring to determine whether automatic alerts reduce shocks caused by lead fractures.…”