CIED Interrogation/Programming Report

Patient: [Full name] | DOB: [DOB] | MRN: [Medical record number]

Encounter Date/Time: [Date] [Time] | Location: [Clinic / Inpatient unit / Procedure area]

Device Type: [Pacemaker / ICD / CRT-P / CRT-D / ICM / ILR]

Manufacturer/Model/Serial: [Generator manufacturer] / [Model] / [Serial]

Interpreting Clinician: [Name, credentials]

(Omit sections that do not apply to the specific device type. Always include units and explicit time windows. If data could not be retrieved or a test was not performed, state so with brief reason.)

Reason for Device Check

[Indication: routine follow-up / symptom-driven / post-procedure / pre-operative / MRI evaluation / alert-driven]

[Clinical question for today's evaluation] (If symptom-driven, include symptom synopsis with timing and potential correlation to device events.)

Implanted System Summary

• Generator: [Manufacturer] | [Model] | [Serial] | [Implant date or "Unknown"]
• Leads:
  • [RA / RV / LV / His / LBB area]: [Lead model or "Unknown"] | [Implant date or "Unknown"] (List one line per lead.)
  • (Include abandoned or capped leads if present.)
  • (For ICD/CRT-D) Coil configuration: [Single-coil / Dual-coil / SVC coil active or inactive]

Battery / Generator Status

• Status: [Normal / ERI / EOL] | Voltage: [Voltage] V | Estimated Longevity: [Longevity estimate]
• (For ICD/CRT-D) Capacitor charge time: [Charge time] s

Battery Interpretation: [Summary of battery condition and any alerts] (Explicitly flag if nearing ERI or at EOL with replacement planning trigger.)

Lead Measurements

(One row per active lead. For leadless pacemakers or ICM/ILR, replace with device-appropriate sensing integrity statement.)

• Lead | Sensing (mV) | Capture Threshold (V @ ms) | Impedance (Ω)
• [RA] | [Sensing] | [Threshold] | [Impedance]
• [RV] | [Sensing] | [Threshold] | [Impedance]
• (For CRT) [LV] | [Sensing] | [Threshold] | [Impedance]
• (For ICD/CRT-D) HV/Shock impedance: [Configuration and impedance in Ω]

Lead Integrity Summary: [Stable vs prior / Changes noted] | [Integrity alerts, noise, or oversensing flags: present or none] (Reference prior interrogation date.)

Diagnostics

Time window: Since [last interrogation date]

• Atrial pacing: [AP %] | Ventricular pacing: [VP %]
• (For CRT) BiV/LV pacing: [BiV %] (Add interpretation if suboptimal.)
• (If atrial arrhythmia detection enabled) AT/AF burden: [Burden %]
• (If relevant to management) Rate/activity trends: [One-sentence summary]

Arrhythmia Episodes

Time window: Since [last interrogation date]

• Atrial arrhythmias: [AT/AF burden %; longest episode duration; rate control assessment if relevant]
• Ventricular arrhythmias: [NSVT / VT / VF counts with dates and durations as available]
• (For ICM/ILR) Patient-activated events: [Symptom-rhythm correlation result]
• (For ICD/CRT-D) Therapies delivered: ATP [number, success]; Shocks [number, dates]
• (If therapies delivered) EGM review: [Reviewed / Not reviewed] | [Classification: appropriate / inappropriate / specific arrhythmia type / oversensing] (Do not classify without documented EGM review.)

(If no episodes or therapies: "No stored arrhythmia episodes or therapies delivered since [date].")

Programming

(If no changes made, include only the following line and omit the rest of this section.)

No programming changes made today.

(If changes made, remove the line above and document below using Before → After format.)

• Changes and rationale:
  • [Parameter]: [Before value] → [After value] | Rationale: [Clinical or technical reason]
  • (Repeat for each parameter changed.)
• Post-change verification: [Capture confirmed at V @ ms] | [Sensing confirmed at mV] | [Impedance rechecked Ω]

Impression

• [Safety/therapy issues: shocks, lead integrity concerns, loss of capture, oversensing]
• [Battery status and replacement planning if relevant]
• [Arrhythmia burden and trends]
• [Optimization issues: rate response, CRT pacing percentage, AV/VV timing]

(If normal: "System function is normal; no concerning findings today.")

Plan / Follow-Up

• Follow-up: [Next in-person check timeframe] | Remote monitoring: [Enrolled / Not enrolled; transmission schedule]
• Additional actions: [Additional device check / imaging / EP consultation / medication coordination] (Omit if none.)
• Battery planning: [Generator replacement planning steps and expected timing] (Include only if nearing ERI/EOL.)
• Patient communication: [Results discussed with patient] | [Notifications to referring clinician or inpatient team]
• Patient instructions: [Symptoms warranting urgent evaluation; remote monitoring limitations clarified]

Interpreting Clinician Signature: [Name, credentials] | [Date] [Time]