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, 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.

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 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 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.