Deactivation of ICDs in end-of-life care: A Welsh perspective

An implantable cardioverter defibrillator (ICD) is a small cardiac implant that monitors, detects and treats life-threatening arrhythmias. If a patient has advanced or terminal disease requiring end-of-life care, it is questionable whether life-sustaining treatments such as defibrillation are appropriate. In such situations it is important that patients and their relatives are given the opportunity to discuss elective deactivation of their ICDs. While deactivation is a simple procedure, from a psychological perspective it is sometimes thwarted with challenges for the patient, relatives and health-care professionals. Furthermore, deactivation of an ICD is often left until the last days of life, which can cause unnecessary distress for all concerned. The evidence, the views of patients, relatives and health-care professionals will be explored, along with a description of the development of the All-Wales ICD deactivation pathway.