Addressing end-of-life management in patients with implantable cardioverter defibrillators and pacemakers

Modern medicine benefits from technological advances that both extend life and also improve the quality of life. Cardiovascular implantable electronic devices (CIEDs), including implantable cardioverter defibrillators (ICDs) and per manent pacemakers (PPMs), are commonly used to treat cardiac rhythm disorders. An aging population in the USA, combined with expanding indications, promises an exponential increase in the utilization of these devices. However, challenging ethical dilemmas arise. Mortality rates among CEID recipients remain high due to worsening underlying cardiac disorders, as well as the development of other terminal illnesses [1,2]. Appropriate end-of-life management of these devices can be difficult, as clinicians attempt to balance autonomy with the wellbeing of the patient and the obligation to avoid harm. Furthermore, how these devices should be handled after a patient’s death poses other challenges, as well as opportunities.