Implantable cardioverter defibrillator(ICD) deactivation discussions: Realityversus recommendations

Background: The implantable cardioverter defibrillator (ICD) is a cornerstone in the treatment of life-threateningarrhythmias. As rates of device implantation continue to rise throughout Europe, European and International guidelinesrecommend professionals discuss deactivation with patients. In reality the appropriate therapeutic management of anICD at the end-of-life remains uncertain in the minds of professionals and patients.Aim: To identify current practice and examine professional decision-making for patients with an ICD from time ofimplantation to final documentation and demise.Methods: Retrospective case note review of patients with an ICD who died during a 12 month period at a regionalimplantation centre.Results: Fifty-nine patients were identified and medical notes of 44 of these patients were successfully retrieved. Themajority of patients were male, mean age at time of death 73 years with one-third diagnosed with a malignancy prior todeath. There was no documented evidence patients were informed about deactivation prior to ICD implantation. Endof-life management was discussed with 23 patients and on 17 occasions deactivation was included. Median time fromdiscussion to death was seven days. In total 62.5% of patients who experienced a shock had an active ICD at death, while93.7% who had their ICD deactivated never had a shock (p=0.003).Conclusion: Patients were not adequately informed regarding device deactivation prior to implantation, nor whentheir health deteriorated. The experience of a shock potentially affects professional decision making regarding devicedeactivation