title: EHRA Expert Consensus Statement on the management of cardiovascular implantable electronic devices in patients nearing end of life or requesting withdrawal of therapy.
abstract: The purpose of this Consensus Statement is to focus on implantable cardioverter-defibrillator (ICD) deactivation in patients with irreversible or terminal illness. This statement summarizes the opinions of the Task Force members, convened by the European Heart Rhythm Association (EHRA) and the Heart Rhythm Society (HRS), based on ethical and legal principles, as well as their own clinical, scientific, and technical experience. It is directed to all healthcare professionals who treat patients with implanted ICDs, nearing end of life, in order to improve the patient dying process. This statement is not intended to recommend or promote device deactivation. Rather, the ultimate judgement regarding this procedure must be made by the patient (or in special conditions by his/her legal representative) after careful communication about the deactivation's consequences, respecting his/her autonomy and clarifying that he/she has a legal and ethical right to refuse it. Obviously, the physician asked to deactivate the ICD and the industry representative asked to assist can conscientiously object to and refuse to perform device deactivation.
authors.affiliation: 1Department of Heart and Vessels, University of Florence, Florence, Italy. lpadeletti@interfree.it
authors.forename: Luigi
authors.initials: L
authors.lastname: Padeletti
authors.forename: David O
authors.initials: DO
authors.lastname: Arnar
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Boncinelli
authors.forename: Johannes
authors.initials: J
authors.lastname: Brachman
authors.forename: John A
authors.initials: JA
authors.lastname: Camm
authors.forename: Jean Claude
authors.initials: JC
authors.lastname: Daubert
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Hassam
authors.forename: Sarah
authors.initials: S
authors.lastname: Kassam
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
authors.forename: Michael
authors.initials: M
authors.lastname: Glikson
authors.forename: David
authors.initials: D
authors.lastname: Hayes
authors.forename: Carsten
authors.initials: C
authors.lastname: Israel
authors.forename: Rachel
authors.initials: R
authors.lastname: Lampert
authors.forename: Trudie
authors.initials: T
authors.lastname: Lobban
authors.forename: Pekka
authors.initials: P
authors.lastname: Raatikainen
authors.forename: Gil
authors.initials: G
authors.lastname: Siegal
authors.forename: Panos
authors.initials: P
authors.lastname: Vardas
authors.forename: Paulus
authors.initials: P
authors.lastname: Kirchhof
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Becker
authors.forename: Francisco
authors.initials: F
authors.lastname: Cosio
authors.forename: Peter
authors.initials: P
authors.lastname: Loh
authors.forename: Stuart
authors.initials: S
authors.lastname: Cobbe
authors.forename: Andrew
authors.initials: A
authors.lastname: Grace
authors.forename: John
authors.initials: J
authors.lastname: Morgan
mesh_terms: D032921:Consensus; D017147:Defibrillators, Implantable / Q000941:ethics*; D020878:Device Removal / Q000941:ethics / Q000331:legislation & jurisprudence; D006801:Humans; D010166:Palliative Care / Q000941:ethics* / Q000331:legislation & jurisprudence*; D028701:Patient Rights / Q000941:ethics / Q000331:legislation & jurisprudence; D013727:Terminal Care / Q000941:ethics* / Q000331:legislation & jurisprudence*