Risks of Implanted Defibrillators
Written by Faith Anderson on October 10, 2011
The Adverse Effects of ICDs at the End of Life
Russo began researching the subject of implanted defibrillators at the end of life when he read a horrifying report about the death of a hospice patient who “suffered 33 shocks as he lay dying in his wife’s arms.” Russo also spoke with a friend who’d had a similar experience watching her father die. “My friend got quite confused,” Russo explained. “She didn’t understand why he was jumping around when it looked like he was no longer breathing. His body looked like it was jumping off the bed. It was very upsetting to watch.” When Russo delved into his own patient files, he saw no evidence that anyone had been counseled about the possible adverse effects of having an ICD turned on at the end of life.
Approximately 250,000 to 300,000 ICDs are implanted each year in patients who are at risk of sudden cardiac arrest because their hearts can spin out of rhythm without warning, beating either too fast or in an abnormal pattern. Implanted cardioverter-defibrillators are life-saving battery-operated devices designed to detect these irregular rhythms and to reset the heart by delivering a strong jolt of electricity. Unfortunately, in patients who are near death, the heart can get out of sync and trigger numerous shocks from the ICD as it attempts to restart the heart and establish a normal rhythm. Once implanted, ICDs can be turned off or reprogrammed by a specialist with a computer that is designed to work with the devices.
Few Doctors Fully Inform Patients about the Risks of Activated ICDs
One study cited by Russo indicates that even among patients who have signed a do-not-resuscitate order, or DNR, discussions between doctors and patients about what could happen with an ICD at the end of life took place in fewer than 45% of cases. Other studies showed that healthcare providers were more comfortable talking about DNRs than they were about the possible impact of an activated ICD at the end of life. “One cardiologist said she feared that talking about deactivation with patients would be like ‘shutting off hope,'” Russo reported. While it might be difficult to suggest that a dying patient turn off the ICD, it makes sense to include this discussion at the time the device is implanted. A study cited by Russo however, showed that only 4% of doctors were routinely discussing this issue with patients before their ICD was implanted.
Even if patients aren’t ready to completely turn off an ICD, the device can be reprogrammed so that it works more like a pacemaker, delivering tiny jolts of electricity instead of high-voltage shocks that ICDs deliver in order to completely recalibrate the heart. Ultimately, Russo’s goal in compiling and publishing this report is to spur more discussions about the benefits of turning off implanted defibrillators at the end of life. “Regardless of a provider’s comfort level with the subject,” Russo concluded, “patients have a right to be informed of all treatment options, including ICD deactivation.”