November 2018 -There is a big difference between AICD deactivation and pacemaker deactivation.
More patients (or their surrogates) are requesting the deactivation of cardiac devices at end of life. Some want a more natural death. Others hope for an easier or earlier death. Most have either advanced heart disease or dementia.
Deactivating an AICD may prevent painful shocks at the time of death. It is simple to do and causes no symptoms or immediate change in condition.
Pacemaker deactivation is more complex and much less common. Careful informed consent is important. Symptoms may occur immediately if the intrinsic heart rate is low.
Refusing or withdrawing treatments, even those that reduce symptoms or prolong life, is a patient’s right. Coordination with cardiology and palliative care or hospice can help your patients decide what is right for them.