Key result
Pacemaker deactivation in a pacing-dependent patient yields comfortable death at 18 hours with opioids and benzodiazepines.
This case demonstrates the feasibility and clinical course of capacitous, legal palliative pacemaker deactivation in a pacing-dependent patient.
Supports cautious consideration of pacemaker deactivation in select palliative cases; leaves open need for systematic evidence on outcomes.
A man in his 90s was frail, symptomatic of heart failure and dependent on a pacemaker inserted decades prior for third-degree atrioventricular block. He requested his cardiologist to deactivate the pacemaker so he could die naturally of his underlying cardiac pathology. After 135 days of consultations and advice, the pacemaker was deactivated in a hospice in England. After deactivation, the patient developed bradycardia and hypoxia but remained comfortable and conversant, then gradually became unconscious. Opioid and benzodiazepine were administered at deactivation and later in response to mild symptoms. He died peacefully 18 hours after the capacitous, legal withdrawal of cardiac pacing treatment.
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Petra et al. (2026) studied this question. Pacemaker deactivation in a pacing-dependent patient led to death 18 hours later with maintained comfort and symptom management using opioids and benzodiazepines.
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