Related Experiment Video
Updated: Dec 25, 2025
A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
Published on: February 28, 2012
[Implantable cardiac device deactivation at the end of life]
Massimo Romanò1, Giovanna Gorni2
1Comitato Ordinatore Master Universitario di II Livello in Cure Palliative. Università degli Studi, Milano.
Insights
Discussing deactivation of cardiac implantable devices like ICDs and LVADs is crucial for end-of-life care. Early conversations ensure patient comfort and quality of life when devices no longer benefit them.
Area of Science:
- Cardiology
- Medical Ethics
- Palliative Care
Background:
- Heart failure treatments include drugs, surgery, and implantable devices such as implantable cardioverter-defibrillators (ICDs) and left ventricular assist devices (LVADs).
- Patients with these devices may die from non-arrhythmic causes or device complications, diminishing the devices' benefit and potentially causing suffering.
- Approximately 30% of patients die from non-arrhythmic causes, often without device intervention until the final hours.
Purpose of the Study:
- To provide an overview of ethical, clinical, and communication issues surrounding the deactivation of cardiac implanted devices at the end of life.
- To emphasize the importance of advance care planning and shared decision-making regarding device deactivation.
- To highlight the role of early palliative care implementation, especially for LVAD patients.
Main Methods:
- Literature review and ethical analysis of deactivation decisions for cardiac implantable devices.
- Discussion of clinical scenarios where device deactivation may be considered.
- Exploration of communication strategies for end-of-life discussions with patients and families.
Main Results:
- Deactivation of ICDs and LVADs is ethically complex but necessary when devices no longer align with patient goals or quality of life.
- Advance directives and shared decision-making are essential for respecting patient autonomy in end-of-life device management.
- Palliative care integration is vital for managing symptoms and improving quality of life in advanced heart failure patients, particularly those with LVADs.
Conclusions:
- Early and open communication about deactivating cardiac implantable devices is essential for ethical end-of-life care.
- Shared decision-making, incorporating patient values and advance care planning, should guide deactivation decisions.
- Integrating palliative care ensures comprehensive support for heart failure patients nearing the end of life.
Abstract:
Treatment of patients with heart failure is based on drugs, cardiac surgery and implantable cardiac devices to prevent sudden cardiac death (implantable cardioverter-defibrillator [ICD]), to reverse left ventricular dysfunction associated with left bundle branch block (cardiac resynchronization therapy) or mechanical circulatory support in more advanced phases of heart failure (left ventricular assist devices [LVAD]).During the follow-up, patients may die from progression of their underlying heart disease or from non-arrhythmic causes, such as malignancies, multi-organ failure, stroke, etc., without benefits by implanted devices. Patients implanted with ICD could die from non-arrhythmic causes, without appropriate shocks until the last few days or weeks of their life. These events occur roughly in 30% of patients, mainly in the last 24 h before death. LVAD therapy may induce significant complications, such as infections, hemorrhagic stroke, thromboembolism, right ventricular failure. In these cases, inappropriate and even appropriate shock deliveries by ICD can no longer prolong life and may simply lead to pain and reduced quality of life, as well as LVAD may prolong life with painful distress due to complications. Therefore, it appears important to discuss early with the patients and their relatives about deactivation of ICD or LVAD at the end of life. The goal of this paper is to provide an overview of the ethical, clinical and communication issues of cardiac implanted device deactivation, with a special focus on issues associated with advance care planning, which require shared decision-making, including those related to end of life decisions (advance directives). Palliative care should be early implemented, particularly in patients with LVAD.
More Related Videos
06:10Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
07:39Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock
Published on: August 16, 2021
Related Concept Videos
01:29Cardiomyopathy V: Interprofessional Care
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:18Endocarditis III: Medical Management