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A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
Published on: February 28, 2012
Implantable cardioverter defibrillator deactivation and end-of-life: British Heart Rhythm Society practical consensus
Honey Thomas1, Jane Wallace2, Paul Foley3
1Department of Cardiology, Northumbria Healthcare NHS Foundation Trust, North Shields, UK Honey.Thomas@northumbria-healthcare.nhs.uk.
Insights
Patients with implantable cardioverter defibrillators (ICDs) should discuss deactivating shock functions for end-of-life care. This ensures comfort and avoids potentially distressing shocks or delayed natural death.
Area of Science:
- Cardiology
- Medical Ethics
- Palliative Care
Background:
- Implantable cardioverter defibrillators (ICDs) are increasingly implanted to treat ventricular arrhythmias and reduce mortality in high-risk patients.
- Patients with ICDs are living longer, leading to a growing number with limited prognoses due to cardiac or non-cardiac conditions.
- Non-cardiac healthcare teams often care for these patients and may lack familiarity with ICDs.
Purpose of the Study:
- To highlight the importance of discussing ICD deactivation for high-quality end-of-life care.
- To address the risks of continued ICD shock therapy in patients nearing the end of life.
- To provide guidance for healthcare professionals on managing ICDs in palliative care settings.
Main Methods:
- The British Heart Rhythm Society developed a practical document for healthcare professionals.
- The document includes information on ICD types, ethical and legal considerations, and deactivation procedures.
- It emphasizes timely discussions between healthcare providers and patients regarding ICD deactivation.
Main Results:
- Failure to deactivate ICD shock functions can lead to painful and distressing shocks in the final days of life.
- Continued ICD therapy may unnaturally delay death, contrary to patient wishes if discussed.
- The developed guidance aims to promote awareness and best practices for ICD management in end-of-life care.
Conclusions:
- Discussing and potentially deactivating ICD shock functions is crucial for ethical and patient-centered end-of-life care.
- Healthcare professionals need clear guidance to support patients and families in these sensitive discussions.
- Proactive management of ICDs ensures patient comfort and respects individual end-of-life preferences.
Abstract:
Implantable cardioverter defibrillators (ICDs) are implanted in increasing numbers of patients with the aim of treating ventricular arrhythmias in high-risk patients and reducing their risk of dying. Individuals are also living longer with these devices. As a result, a greater number of patients with an ICD will deteriorate either with worsening cardiac failure, another non-cardiac condition or general frailty and will have a limited prognosis. Frequently they will be cared for by non-cardiac teams who may be less familiar with ICDs. Therefore, to ensure the person receives high-quality end-of-life care, they should have the opportunity to consider and discuss the option to deactivate the shock function of their ICD. If the ICD shock therapy is not discontinued, there is an increased risk that as a person reaches the last days of life, the ICD may deliver painful shocks which are distressing. There is also a risk that the device may delay the person's natural death which the person would not have chosen if they had been given the opportunity to discuss discontinuation. The British Heart Rhythm Society has developed a practical document to support all healthcare professionals who are caring for patients who have an ICD. This includes descriptions of different device types, ethical and legal aspects, timing and nature of ICD discussions and practical advice regarding how the devices may be deactivated. It aims to promote awareness and timely discussion between professionals and patients and to encourage best practice.
