Device Interrogation Follow-Up Note (Pacemaker/ICD)

Encounter Date: [Date]

Modality: [In-person / Remote transmission]

Reason for Interrogation: [routine follow-up / battery check / post-implant / symptoms / shock / alert]

Device: [PM / ICD / CRT-P / CRT-D], [Manufacturer], [Model]

Implant Date: [Date]

Indication: [Clinical indication for device]

Performed By: [Name, credentials]

Interpreted By: [Name, credentials]

Interval History

[Symptoms and clinical context since last check] (Summarize palpitations, syncope/presyncope, dyspnea, shock awareness, and device-pocket symptoms. Include context if prompted by alert or therapy delivery. For routine asymptomatic remote transmissions, state exactly: "No interval symptoms reported.")

Device Data

(If any data are unavailable, state "Not available on this transmission" rather than leaving blank or implying normal.)

• Battery: [Status and estimated longevity] (Note ERI/EOL if applicable)
• Leads: (Include only implanted chambers; note trends or concerning values)
  • RA: [Sensing amplitude]; [Capture threshold at pulse width]; [Impedance]
  • RV: [Sensing amplitude]; [Capture threshold at pulse width]; [Impedance]
  • LV: [Sensing amplitude]; [Capture threshold at pulse width]; [Impedance] (Omit if no LV lead)
• Pacing: [% atrial pacing]; [% ventricular pacing]; [% BiV pacing if CRT]
• Settings: [Mode]; [Lower rate]; [Upper tracking/sensor rate] (For ICD/CRT-D include tachytherapy zones and therapy status)
• Episodes & Therapies:
  • AT/AF: [Burden and longest episode duration] (If none: "No AT/AF detected")
  • VT/VF: [Episode count, therapies delivered (ATP/shocks), appropriateness] (If none: "No VT/VF episodes; no therapies delivered")
• Alerts: [Active alerts such as lead integrity, impedance, or connectivity issues] (If none: "None")

Programming Changes

(If no changes, state exactly: "No programming changes made.")

• [Parameter]: [Prior value] → [New value] — Rationale: [Clinical reasoning]

Assessment

[Narrative interpretation of device function and clinical significance] (State whether device function is normal or abnormal and why. Address clinical significance of arrhythmia episodes or therapies, including appropriateness when determinable. Correlate symptoms with device-recorded events if applicable. Comment on battery trajectory and lead stability. Avoid restating data without interpretation.)

Plan

• Follow-up: [Timing of next in-person check and/or remote transmission] (Note triggers for earlier evaluation: ERI approach, new alerts, symptoms, or therapy delivery)
• Remote Monitoring: [Enrollment status, transmission cadence, patient instructions] (Include that remote monitoring is not emergency care)
• Coordination: [Communication to other providers, planned procedures, medication considerations] (Include only if applicable)

Device report and representative EGMs stored in the medical record.