title: Deactivation of implantable cardioverter-defibrillators at end of life.
abstract: It is inevitable that all patients with implantable cardioverter-defibrillators (ICDs) will die during extended follow-up. End-of-life care planning may become appropriate as a patient's condition deteriorates. There is concern about multiple futile shocks in the final hours of life, although the incidence of this problem has been estimated at only 8-16%. Despite broad consensus that ICD deactivation should be discussed as part of end-of-life care planning, the effect of ICD deactivation, in particular whether life expectancy is altered, is uncertain. Many clinicians are reluctant to discuss ICD deactivation. Many patients have misconceptions regarding ICD function and value longevity above quality of life. As such, ICD deactivation is often discussed late or not at all. The management of ICDs in patients approaching death is likely to become a major problem in the coming years. This article will discuss directions in which clinical practice might develop and areas for future research.
authors.affiliation: Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, CB23 3RE, UK. s.j.pettit@doctors.org.uk.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Pettit
authors.forename: Colette E
authors.initials: CE
authors.lastname: Jackson
authors.forename: Roy S
authors.initials: RS
authors.lastname: Gardner
mesh_terms: D001291:Attitude of Health Personnel; D001294:Attitude to Health; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D006801:Humans; D013727:Terminal Care / Q000941:ethics* / Q000379:methods