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Your ICD can save your life.
Your ICD (implantable cardioverter-defibrillator) is always checking your heart rate and rhythm. If the ICD detects a life-threatening rapid heart rhythm, it tries to slow the rhythm to get it back to normal. If the dangerous rhythm doesn't stop, the ICD sends an electrical shock to the heart to restore a normal rhythm.
Your ICD may also work as a pacemaker. It can fix a heart rate that is too fast or too slow. It may do so without using a shock.
Even though an ICD can help fix heart rate or rhythm problems, you may not want this at the end of life. Many people consider turning off their ICD when their health goal changes from living longer to getting the most comfort possible at the end of life. The shocks the ICD delivers are painful. Not being shocked will make you more comfortable at the end of life.
As you plan for your future and your end of life, include plans for your ICD. The decision to turn off your ICD is part of the medical treatment you want at the end of life. You can put this information in your advance directive.
Turning off your ICD is legal. It isn't considered suicide. The decision to leave on or turn off your ICD is a medical decision you make based on your values.
Turning off an ICD isn't hard. The ICD isn't taken out of your chest, and you don't need surgery. Your doctor will use a computer to reprogram the ICD so that it doesn't give you shocks. This isn't painful.
Turning off the ICD won't cause death, and it won't make you feel worse. But because the ICD won't give you a shock if you have a life-threatening heart rhythm, this type of heart rhythm could lead to death.
Some ICDs are combined with a pacemaker. You can turn off the ICD without turning off the pacemaker. Turning off a pacemaker means your heart might not pump blood as well as it should. This could make you feel worse instead of more comfortable.
Depending on your heart condition, turning off a pacemaker could result in death.
You make the decision about whether or not you want to turn off your ICD. It can be a tough decision to make, but you don't have to make it alone. Look to your family, your doctor, your spiritual adviser, and your friends for help and support.
Other Works Consulted
Lampert R, et al. (2010). HRS Expert Consensus Statement on the Management of Cardiovascular Implantable Electronic Devices (CIEDs) in patients nearing end of life or requesting withdrawal of therapy. Heart Rhythm, 7(7): 1008–1026. Available online: http://www.hrsonline.org/Policy/ClinicalGuidelines/upload/ceids_mgmt_eol.pdf.
Russo JE (2011). Deactivation of ICDs at the end of life: A systematic review of clinical practices and provider and patient attitudes. American Journal of Nursing, 111(10): 26–35. Also available online: http://journals.lww.com/ajnonline/Fulltext/2011/10000/Original_Research__Deactivation_of_ICDs_at_the_End.18.aspx.
Current as of:
March 12, 2014
Kathleen Romito, MD - Family Medicine & Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
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