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Review
. 2020 Nov;28(11):565-570.
doi: 10.1007/s12471-020-01438-6.

Implantable cardioverter defibrillators at the end of life: future perspectives on clinical practice

R Stoevelaar  1 , A Brinkman-Stoppelenburg  2 , R L van Bruchem-Visser  3 , A G van Driel  4   5 , R E Bhagwandien  6 , D A M J Theuns  6 , J A C Rietjens  2 , A van der Heide  2
Affiliations
Review

Implantable cardioverter defibrillators at the end of life: future perspectives on clinical practice

R Stoevelaar et al. Neth Heart J. 2020 Nov.

Abstract

The implantable cardioverter defibrillator (ICD) is effective in terminating life-threatening arrhythmias. However, in the last phase of life, ICD shocks may no longer be appropriate. Guidelines recommend timely discussion with the patient regarding deactivation of the shock function of the ICD. However, research shows that such conversations are scarce, and some patients experience avoidable and distressful shocks in the final days of life. Barriers such as physicians' lack of time, difficulties in finding the right time to discuss ICD deactivation, patients' reluctance to discuss the topic, and the fragmentation of care, which obscures responsibilities, prevent healthcare professionals from discussing this topic with the patient. In this point-of-view article, we argue that healthcare professionals who are involved in the care for ICD patients should be better educated on how to communicate with patients about ICD deactivation and the end of life. Optimal communication is needed to reduce the number of patients experiencing inappropriate and painful shocks in the terminal stage of their lives.

Keywords: Advance care planning; Decision-making; End-of-life care; Implantable cardioverter defibrillator; Palliative care; Withholding treatment.

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Conflict of interest statement

R. Stoevelaar, A. Brinkman-Stoppelenburg, R.L. van Bruchem-Visser, A.G. van Driel, R.E. Bhagwandien, D.A.M.J. Theuns, J.A.C. Rietjens and A. van der Heide declare that they have no competing interests.

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