Deactivation of Implantable Cardioverter-Defibrillators in Heart Failure: A Systematic Review

Implantable cardioverter-defibrillator aids in the prevention of cardiac arrest by delivering an electrical shock in the presence of life-threatening ventricular arrhythmias. Although implantable cardioverter-defibrillators are essential to sustain life in patients with end-stage heart failure, it is important to consider the option for prompt deactivation of implantable cardioverter-defibrillators to prevent inappropriate electrical shocks at the end of life where death is inevitable. In this systematic review, available literature was reviewed, using six electronic databases, to identify problems that may delay the deactivation of implantable cardioverter-defibrillators and address possible considerations for implantable cardioverter-defibrillator management to improve end-of-life care. Studies reported low occurrence of deactivation discussions, lack of knowledge regarding implantable cardioverter-defibrillator deactivation among most patients, and provider's perception of being unqualified to initiate discussion and perform deactivation of implantable cardioverter-defibrillator. A need for additional patient and provider education and periodic discussions between patient and provider on implantable cardioverter-defibrillator deactivation should occur, as well as development of protocol or policy to guide care at the end of life.