Device Troubleshooting: Lessons from a Device Company Call Center

Dear Readers, Those who care for patients with implantable pacemakers and defibrillators continue to rely on the technical expertise of device representatives. Device representatives are commonly present at the time of implant and are highly informed about company-specific details of the device being implanted, and are an outstanding resource for troubleshooting. Each device company also provides invaluable technical services over the phone to help answer questions that arise at the time of implant and follow-up. When questions cannot be answered in most device clinics, the first phone call is often to technical services. These “call centers” are a wealth of information and have a large amount of troubleshooting experience. An understanding of the most commonly asked questions of these centers could provide insight into what the biggest problems are in the real world. We recently invited the Principal Consultant from Boston Scientific’s Cardiac Rhythm Management Technical Services Department, Carol Huss, to visit. She graciously shared with our Heart Rhythm team and trainees what she identified as the top ten questions asked of their center. She provided us with the following list. 1. Patient is having surgery – how do I stop it from shocking? Can I use a magnet on this device? 2. Can the patient use (substitute any piece of electrical/recreational/medical equipment)? Is this a source of EMI? 3. How much longer will this device last? What are the ERI indicators? 4. Specs: Does the device have (substitute your favorite feature)? Size/shape/longevity. 5. EGM/therapy history review: Why did the device deliver (or not deliver) therapy? How do I change programming to change these decisions? 6. What device/leads does the patient have? 7. Why is this device beeping? 8. Is this device included in any advisories? 9. Where’s the (substitute any device parameter) on the screen? Assistance with programming features/using programmer. 10. Can I implant this device on this lead? Device compatibility, functionality. This list of commonly asked questions identifies continued knowledge gaps among those who care for patients with devices, and provides insights into continued room for improvement in the field of device therapy. Given that the most commonly asked question is related to perioperative potential for electromagnetic interference, it seems that there is a strong need for a “Bovie-safe” device. Although there is a lot of ongoing work to develop an MRI-safe device, the development of a device that is immune to interference by electrocautery might address a problem that has a greater day-to-day impact. The willingness of the device companies to share this type of information is appreciated. We should continue to look at what questions are being asked of Technical Services Departments to help find opportunities to improve device therapy. Sincerely, Bradley P. Knight, MD, FACC, FHRS Editor-in-Chief, EP Lab Digest