A survey on the follow-up practices of patients with implantable cardioverter defibrillators (ICDs) in Canada was conducted by the Canadian Working Group on Cardiac Pacing in 1999. The survey identified the need for national guidelines. The present guidelines for ICD follow-up represent a consensus statement of the Canadian Working Group on Cardiac Pacing. They recommend that patients be assessed before hospital discharge, at two to 12 weeks following implantation, six months after implantation, and at a minimum of every six months thereafter. More frequent assessments may be required for some patients depending on associated cardiovascular problems and specific ICD devices. A typical follow-up visit should include a targeted cardiovascular assessment, interrogation of the ICD, review of telemetered data, assessment of the underlying rhythm, pacing and sensing thresholds, lead impedance and appropriate reprogramming of ICD parameters to optimize device function and longevity.

Introduction: Not all patients experience recurrent sustained ventricular tachyarrhythmias after placement of an implantable cardioverter defibrillator (ICD). We evaluated the clinical and electrophysiologic predictors of ventricular tachycardia (VT) and ventricular fibrillation (VF) recurrence following ICD implantation. Methods and Results: Consecutive patients (n = 133) underwent 4 ± 3 serial electrophysiologic studies (EPS) over 50 ± 26 months following ICD implantation. Sustained VT/VF could always be induced during follow‐up EPS in 49 patients; sustained VT/VF was sometimes induced during follow‐up EPS in 47 patients; and sustained VT/VF could never be induced during follow‐up EPS in 37 patients. Spontaneous VT/VF requiring ICD therapy occurred in 107 patients during follow‐up. Patients with sustained VT/VF that was always inducible or sometimes inducible during follow‐up experienced more frequent episodes of VT/VF following ICD implant (20.5, 95% CI 12.7–33.0; and 17.8, 95% CI 11.3–28.1 episodes/patient respectively; vs 3.0, 95% CI 2.0–4.6 episodes/patient for patients with VT/VF never induced, P < 0.001 ). Inducibility of sustained VT/VF post‐ICD implant (P < 0.001) and sustained VT as the presenting arrhythmia (P = 0.02) were independent predictors of spontaneous VT/VF recurrence. Conclusion: Reproducibly inducible VT/VF following ICD implantation predicts a high probability of VT/VF recurrence and identifies a cohort of patients who experience frequent episodes of VT/VF over time. Persistent noninducibility of sustained VT/VF identifies a group of patients who experience no or very few episodes of VT/VF recurrence. (J Cardiovasc Electrophysiol, Vol. 14, pp. 492‐498, May 2003)