Palliative pacemaker deactivation for a pacing-dependent patient

A man in his 90s was frail, symptomatic of heart failure and dependent on a pacemaker inserted decades prior for third-degree atrioventricular block. He requested his cardiologist to deactivate the pacemaker so he could die naturally of his underlying cardiac pathology. After 135 days of consultations and advice, the pacemaker was deactivated in a hospice in England. After deactivation, the patient developed bradycardia and hypoxia but remained comfortable and conversant, then gradually became unconscious. Opioid and benzodiazepine were administered at deactivation and later in response to mild symptoms. He died peacefully 18 hours after the capacitous, legal withdrawal of cardiac pacing treatment.