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Implantable Cardioverter Defibrillators (ICDs) are used for patients who have had either a sudden previous cardiac arrest or are at high risk of sudden cardiac death from an arrhythmic cause (NICE 2014).
An ICD can deliver either rapid burst pacing or a shock with the aim of terminating VT/VF arrhythmia and restore normal cardiac electrical function. Most ICDs also function as a pacemaker to either prevent bradycardia or as part of cardiac resynchronisation therapy (CRT). CRT devices synchronise contraction of the left and right ventricles and thereby reduce symptoms in some people with heart failure. These are referred to as CRT-D devices.
The pacemaker and ICD function of each device is programmable independently of each other (Resuscitation Council UK, 2015).
Due to the increasing indications for ICD implantation, the number of people with ICDs has also increased. People are also living longer with these devices. As a result, an increasing number of patients with an ICD will deteriorate either with worsening cardiac failure or another non-cardiac condition and will have a terminal prognosis (Resuscitation Council UK 2015). Therefore, to ensure the person receives high-quality end-of-life care, they should have the opportunity to consider and discuss the option to deactivate the shock function of their ICD.
If the ICD is not deactivated, there is an increased risk that as a person reaches the last days of life, the ICD will deliver multiple, painful shocks which are distressing (R Stoevelaar et al, 2018). There is also a risk that the device may delay the person’s natural death which the person would not have chosen if they had been given the opportunity to discuss deactivation.
Disclaimer
These Guidelines are intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.
Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.
Whilst SPAGG takes every care to compile accurate information , we cannot guarantee its correctness and completeness, and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.