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Management of cardiac implantable electronic devices in patients receiving palliative care

Ann C Garlitski, MD, FACC, FHRS
Section Editor
R Sean Morrison, MD
Deputy Editor
Brian C Downey, MD, FACC


Discontinuation of cardiac implantable electronic device (CIED) therapy, which encompasses both pacemakers and defibrillators, is a complicated issue. For many patients, these are life-sustaining therapies. In 2010, the Heart Rhythm Society (HRS) released an expert consensus statement on the management of CIEDs in patients nearing the end of life or requesting withdrawal of therapy [1]. This statement outlines the ethical, legal, and religious principles that underlie the decision-making process to withdraw CIEDs.

The issues related to changes in CIED therapy, including specific issues related to palliative care, will be discussed here. Additional discussion of the ethical issues involved in palliative care is presented separately. (See "Ethical issues in palliative care".)


Available data to guide providers in counseling patients have been obtained from studies of implantable cardioverter-defibrillator (ICD) interrogations and interviews with families.

Interviewing family members of deceased patients in a single practice found that approximately 20 percent of patients with ICDs had the device discharge in the last month of life [2].

A retrospective chart review of 98 patients with ICDs from the Multicenter Automated Defibrillator Implantation Trial II who later died found that 15 percent chose to have their ICDs deactivated. Ten patients whose ICDs remained activated received shocks during the 24 hours before death [3].

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Literature review current through: Nov 2017. | This topic last updated: Jul 13, 2016.
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