Very Ill May Prefer to Turn Off Heart Device

Heart patients with implanted defibrillators may choose to shut off device when very sick

(RxWiki News) Like pacemakers, implantable cardioverter-defibrillators (ICDs) are implanted in the chest to regulate arrhythmias (irregular heartbeats). ICDs, however, are programmed to deliver a high-voltage shock to return a heart to a normal beat.

Many patients who have advanced illness would opt to switch off their ICDS if given the choice, according to a new study.

"Know the side effects of having an implantable cardioverter-defibrillator."

John Dodson, MD, postdoctoral cardiology research fellow at Brigham and Women's Hospital in Boston, led this study of 95 patients with ICDs. He conducted the research with colleagues from Yale University, where Dr. Dodson completed his fellowship training.

The average patient age was 71, and 72 percent of the patients were male.

ICDs are similar to pacemakers. Pacemakers give off low-energy electrical pulses that help regulate heart rhythms that are too slow, too fast or irregular. ICDs do this as well, but they can also give a painful jolt to keep a patient’s heart going. The shock may keep a patient alive if he or she goes into sudden cardiac arrest, in which the heart stops beating.

The shock from an ICD can cause momentary discomfort, which is described by some patients as being “kicked in the chest, ” according to Johns Hopkins Medicine. ICDs must be checked every three to four months and replaced every four to eight years.

While previous studies have found that most patients with ICDs don’t want their devices turned off, Dr. Dodson’s report found that 71 percent of patients surveyed wanted ICD deactivation in one or more scenarios.

The five scenarios were permanent inability to get out of bed; permanent memory problems; being a burden to family members; dependence on a breathing machine for longer than one month; and advanced incurable disease.

Investigators found that subjects who had disabilities that made it difficult to carry out the functions of daily life were more likely to choose ICD deactivation than those who did not have disabilities.

Those who said they might want their ICD switched off because they have an incurable disease, such as terminal cancer, may not wish to prolong their lives under the threat of such a sudden shock.

Dr. Dodson’s research highlights a recent Heath Rhythm Society consensus statement that recommends “proactive communication with patient regarding deactivation” to prevent shocks at the end of life that do not meaningfully prolong survival.

The study was published in a research letter that appeared online January 28 in the journal JAMA Internal Medicine.

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Review Date: 
February 9, 2013