Deactivation of implantable cardioverter-defibrillators: results of patient surveys

The indications for implantable cardioverter-defibrillators (ICDs) have been expanding, especially for primary prevention of sudden cardiac death. Implantable cardioverter-defibrillator saves lives; however, in near end-of-life situations linked to incurable diseases, the question arises as to whether or not to turn off the ICD to avoid excessive numbers of shocks as the heart begins to fail. This study examined the wishes of a cohort of ICD recipients. Consecutive recipients of ICDs for primary or secondary prevention of sudden cardiac death were examined during a routine out-patient follow-up visit. Subjects completed a written survey about expected ICD benefits, feelings and circumstances under which they would want to deactivate the device. One hundred and nine patients fully completed the survey. Mean age was 67.6 8.7 years, 91 (83.5) were male and the mean systolic ejection fraction was 31.5 10.9. The severity of symptoms of heart failure according to the New York Heart Association classification was 2.1 0.59 at implantation. Ninety-nine (90.8) patients felt more secure and safe following ICD implantation and 66 (60.6) patients reported a sense of improved health status after implantation. Thirty-one (28.4) patients had experienced an ICD shock. Fifty (45.9) patients indicated that they had never considered ICD deactivation during near end-of-life situations. This topic had been discussed with only eight (7.3) patients. Forty-four (40.1) patients wanted more information about ICD deactivation. On the other hand, 10 (41.7) patients from secondary prevention and 19 (22.4) from primary prevention groups categorically refused more information or further discussion on this topic (P 0.058). Most ICD recipients felt safer following ICD implantation and most wanted more information regarding ICD deactivation. However, a significant number of patients (especially, secondary prevention patients) had no interest in receiving additional information about this topic.