Cardiac Device Deactivation

Cardiac devices are designed to keep the heartbeat of a person in proper rhythm for those who have an irregular heartbeat due to problems caused by the heart’s inability to pump blood throughout the body. This article discusses the features of patients who underwent cardiac device deactivation and patient outcomes.

According to the centers for disease control and prevention, about 6.5 million adults in the US have heart failure and one in eight deaths were related to heart failure in 2017.¹ These can continue to rise due to changing lifestyles.

Cardiac devices are designed to keep the heartbeat of a person in proper rhythm for those who have an irregular heartbeat due to problems caused by the heart’s inability to pump blood throughout the body. A heart device is inserted when there is heart failure with reduced ejection fraction.

Types of cardiac devices are a pacemaker, implantable cardioverter defibrillator or ICDs, and heart rhythm monitors called loop recorders. These devices are said to be medically and technically assured to expand the longevity of a patient with heart failure. Knowing the features of cardiac device deactivation is important.

A very few patients are aware of the features of the cardiac device deactivation option. Some patients do receive a shock from their ICDs during their dying process thus asking for deactivation when they recognize the seriousness of their illness. Timely planning and discussion about the cardiac device deactivation are very important as it reduces the risk of dying with a shock. It also helps reduce the ethical dilemmas that the patient, surrogates and care providers may carry. An end to end the discussion about the process and educating the patient of all the high-end risks and assessments are very important. Decisions about the deactivation of the device should be thoroughly discussed with the patient. If the patients lack capacity in involvement, decisions must be taken according to the proper law within their best interest. ICDs have a built-in pacemaker where the shocking action of the ICD can be turned off and pacemaker function can continue.

It is possible that patients who have cardiac devices implanted within them for a normal rhythmic heartbeat, at some point in time, may physically or emotionally ask for the deactivation of the cardiac device. Patients who themselves decide to go through device deactivation, consider taking palliative medicine than the ones whose surrogates make the decision. Doctors suggest taking medication to ensure proactive management of symptoms.

Some of the important features of the cardiac device include important points like

• Patients carrying cardiac devices should keep a distance from noise, cell phones and anything containing high magnetic space.
• People should be aware of the health condition of the patient so that they may get help if health fails suddenly.

The experience of one or multiple shocks that happens within arising consistent pain creates negative responses of anxiety and distress within the patient and the caregiver. Sometimes a patient with an implanted device can experience a cardiorespiratory arrest uncertain whether the device presents a risk to the person. The need for the removal of the device must be taken into consideration before deactivating it. It is also necessary to know the patient outcomes and features of cardiac device deactivation.
Factors to be taken into consideration when deactivating cardiac device deactivation

The Permission Of The Patient (If They Are Capable Of Decision Making): discussion of device management at the initial time of the illness and implantation though in reality, hardly anyone discusses the patient’s wish. The medical situation of the patient is essential for implantation of the device. Communication between the doctor and the family is very important to understand the patient’s past medical records.

The Type Of Device Used: devices differ in their therapy capabilities. Each patient is provided with an identification card with the details of the product and the company contact number. Though if the patient is not carrying the identification card and the medical records are unavailable, there are other ways, e.g., through a chest x-ray report. These details help in deciding the cardiac device deactivation.

Temporary deactivation is sometimes done to see if the device is working properly whilst correct measures are taken to deliver proper treatment. Cardiac device deactivation maybe even necessary during certain treatments like surgery or radiotherapy. Sometimes cardiac device deactivation is the withdrawal of treatment, which is considered as voluntary euthanasia or assisted suicide. However, voluntary suicide due to the withdrawal of medical treatment is taken to the court for legal permission Clinical decisions must take into consideration the laws of the local jurisdiction. As the patient outcomes depend on the cardiac device deactivation, the decision must be taken very carefully. Some people with cardiac devices implanted may stop visiting for their checkups, which makes them unaware of the underlying illness. In some cases, the condition can worsen and the patient is getting prone to which would eventually become the cause of their death.

The request for a cardiovascular implantable electronic device is mostly for tachycardia therapies only where normally surrogate decision-makers make such requests.²

However, most patients die shortly after the deactivation of the device which may consider the patient’s underlying illness. In this age, a lot of US patients take the help of cardiac devices. There may be a subsequent cardiac illness in the future, which will make the device inefficient and will act as a barrier to natural death making the patient suffer from the ongoing working of the device or even shocks from the ICDs can be painful. Thus some of the patients or their surrogates decide to deactivate the device overtime for a peaceful death to the seriously ill patients who no longer desire the therapies. However, some object the deactivation of the device for patients who are strongly dependent on the device as that can raise symptoms of heart failure or rapid death.

It is seen that most of the patients who prefer CIED (cardiovascular implantable electronic device) deactivation is trying to avoid shock during the dying process. Whereas it is argued whether deactivating bradycardia therapies in PM-dependent patients is illegal. Most of the CIED deactivation is asked by the surrogates of the patients as they cannot bear the burden of decisions making. It is very likely for surrogates to request deactivation in bradycardia therapy as it involves seriously ill patients without decision-making capacity unlike in tachycardia therapy, which is usually made by decisional capable patients who urge to avoid shocks. Sometimes the patient expresses their clear wish not to receive any information or discussion about the process as it will create a risk of health burden, in that case, the doctor should respect the patient’s will and the patient’s choice should be recorded in their health statement.

Contrary to the belief, sudden deactivation of a pacemaker would not lead to quick and painless death as a majority of the population is not pacemaker dependent whereas those who are dependent would lead to asystole and death. It sometimes leads to slow failure of organs, which is known as symptomatic bradycardia, which can result in a slow difficult death. Most of the patients have a poor or terminal prognosis. ICDs are used to prevent sudden painful death caused by ventricular fibrillation. ICD shocks can be badly disturbing in the dying process of a terminally ill patient for which reason patients should be initially informed during the implantation of ICDs. Whereas pacemakers should be left intact in a dying patient as there are adverse effects of disabling a pacemaker.

With faulty dietary and lifestyle habits, the chances of heart failure are expected to rise in the coming years. Through technology has brought enough ways to expand life expectancy in patients with heart failure, they should be educated about the limitations and the conditions. It must be ensured that the person with the device receives proper care and medical attention. However, the presence of ICD at the end of life can create physical and emotional pain. The outcomes of patients who underwent cardiac device deactivation must also be taken into consideration. The psychological health of the patient plays a very important role in deactivating the device voluntarily.

The burden of the treatment and the special care of the patient make it difficult to live a healthy life. The prolonged continuation of the device causes not only painful and lengthy death but it also makes the person vulnerable to mental distress, loss of dignity, resource depletion, the emotional and spiritual burden associated with a prolonged illness, degradation in the quality of life. The presence of these burdens with no hope of healing effects, the device automatically becomes ineffective, in which cases, cardiac device deactivation is justified.

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