Deactivating implanted cardiac devices in terminally ill patients: practices and attitudes

Background: Clinicians may receive requests to deactivate pacemakers and implantable cardioverter-defibrillators (ICDs) in terminally ill patients.
Methods: We describe practices and attitudes regarding deactivation of pacemakers and ICDs in terminally ill patients among physicians, nurses, and others who manage treatment of patients with implanted cardiac devices and among field representatives of device manufacturers. A Web-based survey was provided to Heart Rhythm Society members and to representatives of two manufacturers of implantable cardiac devices. Measurements were the answers of 787 respondents.
Results: Of the respondents, 86.8% reported involvement in requests for ICD deactivation and 77.6% reported involvement in pacemaker deactivation (P < 0.001). Having cared for a terminally ill patient for whom the respondent or a physician had ordered device deactivation was common (95.4% for ICDs vs 84.8% for pacemakers; P < 0.001). Having personally deactivated a device was also common (92.4% for ICDs vs 76.6% for pacemakers; P < 0.001). More respondents said they were comfortable with personally deactivating an ICD than deactivating a pacemaker (56.7% for ICDs vs 34.4% for pacemakers; P < 0.001). Respondents reported that the industry representative is the individual who deactivates the device most of the time (59.3% for ICDs and 49.7% for pacemakers).
Conclusions: Deactivation of implanted cardiac devices in terminally ill patients is common. Practices and attitudes associated with pacemaker deactivation differ significantly from those associated with ICD deactivation. Professional groups should develop guidelines for managing requests for implanted cardiac device deactivation and should clarify the role of device industry representatives in these deactivations.