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ICD generator replacement in severe frailty — SCE Geriatric Medicine MCQ

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HardPalliative careICD generator replacement in severe frailtySCE Geriatric Medicine

An 81-year-old has abrupt unexplained blackouts without prodrome approximately every two months. Examination, 12-lead ECG, echocardiography and carotid sinus massage are unrevealing. Which rhythm investigation is most likely to capture a symptom-rhythm correlation?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — An implantable event recorder with automatic and patient activation

Explanation lettering: D = shown as A · A = shown as C · C = shown as D

C is correct: NICE CG109 matches ambulatory monitoring duration to event frequency. With episodes less frequent than every two weeks, an implantable event recorder is preferred and should offer both automatic and patient-activated detection. A 24-hour or seven-day monitor has a very low chance of coinciding with a two-monthly event. Tilt testing should not precede ambulatory ECG in otherwise unexplained syncope and is reserved for selected recurrent vasovagal presentations where a cardioinhibitory response would alter management.

Reference: NICE CG109: Transient loss of consciousness: https://www.nice.org.uk/guidance/cg109/chapter/Recommendations