Implanted cardioverter defibrillators (ICDs) are an essential part of the management for patients at risk for life threatening arrhythmias. Despite new technologies, all patients ultimately will reach the end of their lives, either because of underlying cardiac disease or another terminal illness. Having an ICD at the end of life may deny a patient the chance of sudden cardiac death and result in a slower terminal disease and pain and anxiety due to shocks from their device. The purpose of this article is to present a focused literature review on the barriers surrounding deactivation of ICDs and to summarize the recommendations of the Heart Rhythm Society Consensus Statement on the management of ICDs in patients nearing end of life or requesting withdrawal of therapy.
BardyG. H.LeeK. L.MarkD. B.PooleJ. E.PackerD. L.BoineauR.. . . IpJ. H. (2005). Amiodarone or an implantable cardioverter defibrillator for congestive heart failure. New England Journal of Medicine, 352, 225-237.
5.
BristowM. R.SaxonL. A.BoehmerJ.KruegerS.KassD. A.De MarcoT.. . . FeldmanA. M. (2004). Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. New England Journal of Medicine, 350, 2140-2150.
6.
ChanP. S.ChowT.KereiakesD.SchlossE. J.WallerT.EagleK.. . . VijanS. (2006). Effectiveness of implantable cardioverter-defibrillators in patients with ischemicheart disease and left ventricular dysfunction. Archives of Internal Medicine, 166, 2228-2233.
7.
EpsteinA. E.JohnP.DiMarcoJ. P.EllenbogenK. A.EstesN. A. M.IIIFreedmanR. A., . . . Society of Thoracic Surgeons. (2008). ACC/AHA/HRS 2008 guidelines for device based therapy of cardiac rhythms abnormalities. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the AACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemaker and Antiarrhythmia Devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Journal of the American College of Cardiology, 51, e1-62.
8.
Eucomed Medical technology. (2009). Cited 2009 0625. Retrieved from http://www.eucomed.com
9.
GoldsteinN.CarlsonM.LivoteE.KutnerJ. S. (2010). Management of implantable defibrillators in hospice. Annals of Internal Medicine, 152, 296-299.
10.
GoldsteinN. E.LampertR.BradleyE.LynnJ.KrumbholzH. M. (2004). Management of implantable cardioverter defibrillators in end-of-life care. Annals of Internal Medicine, 141, 835-838.
11.
GoldsteinN. E.MehtaD.SiddiquiS.TeitelbaumE.ZeidmanJ.SingsonM. . . MorrisonR. S. (2007). “That’s like an act of suicide”: Patients’ attitudes toward deactivation of implantable defibrillators. Journal of General Internal Medicine, 23(Suppl. 1), 7-12.
12.
GoldsteinN. E.MehtaD.TeltebaumE.BradleyE. H.MorrisonS. (2008). “It’s like crossing a bridge”: Complexities preventing physicians from discussing deactivation of implantable defibrillators at the end of life. Journal of General Internal Medicine, 23(Suppl. 1), 2-6.
13.
GrassmanD. (2005). EOL considerations in defibrillator deactivation. American Journal of Hospice and Palliative Care, 22, 179-180.
14.
HammillS. C.KremersM. S.StevensonL. W.HeidenreichP. A.LangC. M.CurtisJ. P.. . . BrindisR. G. (2010). Review of the registry’s fourth year, incorporating lead data and pediatric ICD procedures, and use as a national performance measure. Heart Rhythm, 7, 1340-1345.
15.
HauptmanP. J.SwindleJ.HussainZ.BienerL.BurroughsT. (2008). Physicians attitudes toward end-stage heart failure: A national survey. American Journal of Medicine, 121, 127-135.
16.
HeidenreichP. A.TrogdonJ. G.KhavjouO. A.ButlerJ.DracupK.EzekowitzM. D., . . . Interdisciplinary Council on Quality of Care and Outcomes Research. (2011). Forecasting the future of cardiovascular disease in the United States: A policy statement from the American Heart Association. Circulation, 123, 933-944.
17.
KelleyA. S.CarringtonR.MillerD. H.FinsJ. J.LachsM. S. (2009). Implantable cardioverter-defibrillator deactivation at the end of life: A physician survey. American Heart Journal, 157, 702-708.e1.
18.
KelleyA. S.MehtaS. S.ReidM. C. (2008). Management of patients with ICDs at the end of life (EOL): A qualitative study. American Journal of Hospice and Palliative Care, 25, 440-446.
19.
KobzaR.ErneP. (2007). End-of-life Decisions in ICD Patients with Malignant Tumors. Pacing and Clinical Electrophysiology, 30, 845-849.
20.
KongM. H.FonarowG. C.PetersonE. D.CurtisA. B.HernandezA. F.SandersG. D.. . . Al-KhatibS. M. (2011). Systematic review of the incidence of sudden cardiac death in the United States. Journal of the American College of Cardiology, 57, 794-801.
21.
KramerD. B.KesselheimA. S.SalbergL.BrockD. W.MaiserW. H. (2011). Ethical and legal views regarding deactivation of cardiac implantable electrical devices in patients with hypertrophic cardiomyopathy. American Journal of Cardiology, 107, 1071-1075.
22.
LampertR.HayesD. L.AnnasG. J.FarleyM. A.GoldsteinN. E.HamiltonR. M., . . . Hospice and Palliative Nurses Association. (2010). HRS Expert Consensus Statement on the Management of Cardiovascular Implantable Electronic Devices (CIEDs) in patients nearing end of life or requesting withdrawal of therapy. Heart Rhythm, 7, 1010-1026.
23.
LewisW. R.LuebkeD. L.JohnsonN. J.HarringtonD.CostantiniO.AulisioM. P. (2006). Withdrawing implantable defibrillator shock therapy in terminally ill patients. American Journal of Medicine, 119, 892-896.
24.
MarinkasG.Van ErvenL. (2010). Deactivation of implanted cardioverter-defibrillators at the end of life: Results of the EHRA Survey. European Journal of Pacing, Arrhythmias and Cardiac Electrophysiology, 12, 1176-1177.
25.
MishkinJ. D.SaxonhouseS. J.WooG. W.BurkartT. A.MilesW. M.ContiJ. B.. . . ArandaJ. M.Jr. (2009). Appropriate evaluation and treatment of heart failure patients after implantable cardioverter-defibrillator discharge: Time to go beyond the initial shock. Journal of the American College of Cardiology, 54, 1993-2000.
26.
MorrisonL. J.CalvinA. O.NoraH.StoreyC. P. (2010). Managing cardiac devices near the end of life: A survey of hospice and palliative providers. American Journal of Hospice and Palliative Medicine, 27, 545-551.
27.
MossA. J.ZarebaW.HallW. J. (2002). Multicenter Automatic Defibrillator Implantation Trial II Investigators. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. New England Journal of Medicine, 346, 877-883.
28.
MuellerP. S.HookC.HayerD. L. (2003). Ethical analysis of withdrawal of pacemaker or implantable cardioverter-defibrillator support at the end of life. Mayo Clinic Proceedings, 78, 959-963.
29.
MuellerP. S.JenkinsS. M.BramstedtK. A.HayesD. L. (2008). Deactivating implanted cardiac devices in terminally ill patients: Practices and attitudes. Pacing and Clinical Electrophysiology, 31, 560-568.
30.
National Consensus Project for Quality Palliative Care. (2009). Clinical practice guidelines for quality palliative care. Retrieved from http://www.nationalconsensusproject.org
RaphaelC. E.Koa-WingM.StainN.WrightI.FrancisD. P.KanagaratnumP. (2011). Implantable cardioverter-defibrillator recipient attitudes towards device deactivation. Pacing and clinical electrophysiology, 34, 1628-1633.
33.
SchronE. B.ExnerD. V.YaoQ.JenkinsL. S.SteinbergJ. S.CookJ. R.. . . PowellJ. (2002). Quality of life in the antiarrhythmics trial versus implantable defibrillator trial: Impact of therapy and influence of adverse symptoms and defibrillator shocks. Circulation, 105, 589-594.
34.
SheraziS.DaubertJ. P.BlockR. C.JeevananthamV.Abdel-GadirK.DiSalleM. R.. . . ShahA. H. (2008). Physicians’ preferences and attitudes about end-of-life care in patients with implantable cardioverter-defibrillator. Mayo Clinic Proceedings, 83, 1139-1141.
35.
StewartG. C.WeintraubJ. R.PratibhuP. P.SemigranM. J.CamusoJ. M.BrooksK.. . . StevensonL. W. (2010). Patient expectations from implantable defibrillators to prevent death in heart failure. Journal of Cardiac Failure, 16, 106-113.
36.
TannerC. E.FrommeE. K.GoodlinS. J. (2011). Ethics in the treatment of advanced heart failure: Palliative care and end-of-life issues. Congestive Heart Failure, 17, 235-240.
37.
TungR.ZimetbaumP.JosephsonM. E. (2008). A critical appraisal of implantable cardioverter-defibrillator therapy for the prevention of sudden cardiac death. Journal of the American College of Cardiology, 52, 1111-1121.
38.
WilkoffB. L.AuricchioA.BrugadaJ.CowieM.EllenbogenK. A.GillisA. M.. . . VardasP. E. (2008). HRS/EHRA Expert consensus on the monitoring of cardiovascular implantable electronic devices (CIEDs): Description of techniques, indications, personnel, frequency and ethical Considerations. European Journal of Pacing, Arrhythmias and Cardiac Electrophysiology, 10, 707-725.
39.
ZellnerR. A.AulisioM. P.LewisW. R. (2009). Should implantable cardioverter-defibrillators and permanent pacemakers in patients with terminal illness be deactivated? Deactivating permanent pacemaker in patients with terminal illness. Patient autonomy is paramount. Circulation: Arrhythmia and Electrophysiology, 2, 340-344.
