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Deactivation of Cardiac Devices at the End of Life: Clinical and Ethical Challenges

Marie-Gabrielle Courtès1,2, Fiona Ecarnot3,4, Mathilde Giffard5,6

  • 1Sion Hospital, Avenue du Grand Champsec 80, 1951, Sion, Switzerland. courtes.marie@gmail.com.

Current Heart Failure Reports
|August 13, 2026
PubMed

Insights

Deactivating life-sustaining devices like implantable cardioverter-defibrillators is ethically permissible for heart failure patients. Early discussions and palliative care are crucial for patient-centered decisions regarding device deactivation.

Area of Science:

  • Cardiology
  • Medical Ethics
  • Palliative Care

Background:

  • The use of cardiovascular implantable electronic devices (CIEDs) in heart failure patients is increasing.
  • Device deactivation presents complex clinical and ethical challenges.

Purpose of the Study:

  • To review current evidence and consensus on device deactivation in heart failure.
  • To emphasize the importance of early communication and patient preferences.

Main Methods:

  • Synthesis of the latest evidence and professional society guidelines.
  • Review of ethical and legal permissibility of device deactivation.
  • Analysis of clinical practice gaps in advance care planning.

Main Results:

  • Guidelines permit device deactivation (ICDs, pacemakers, MCS) upon patient/surrogate request.
  • Discussions on device deactivation are recommended during pre-implantation consent but remain infrequent.
  • Deactivating CIEDs can prevent end-of-life shocks, improving quality of life.

Conclusions:

  • Multidisciplinary involvement, including palliative care, is essential for informed decision-making.
  • Early and ongoing communication about device deactivation is vital.
  • Individualized care integrating patient preferences throughout the disease trajectory is necessary.
Abstract

Keywords:
Cardiac deviceCardiologyDeactivationEnd-of-lifeEthics

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