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Report in the American Journal of Nursing Reveals Lack of Discussion About Deactivation of Defibrillators Which May Cause Needless Pain to Patients Facing End of Life

The purpose of this review was to identify factors that delay ICD deactivation discussions

Both patients and providers need better knowledge about deactivating implantable cardioverter defibrillators (ICDs) at the end of life in order to prevent needless pain among terminally ill patients, according to a systematic review published in the October issue of the  American Journal of Nursing  (AJN).  AJN, the leading voice of nursing since 1900, is published by  Lippincott Williams & Wilkins, part of  Wolters Kluwer Health.

The implantable cardioverter defibrillator (ICD) has become a standard treatment for people at risk for life-threatening cardiac arrhythmias. To restore normal heart rhythm, the ICD delivers a high-energy, electrical shock. However in a terminally ill patient, their deaths can be needlessly painful if the ICD delivers shocks during the active phase of dying.  

“Even though an ICD can be deactivated in terminally ill patients so they may experience a more peaceful death, there are no formal practice protocols to address this scenario,” said James E. Russo, MSN, RN, ANP, CCDS, coordinator of the Pacemaker Clinic, Department of Veterans Affairs Medical Center, New York, NY.  “The purpose of this review was to identify factors that delay ICD deactivation discussions; highlight ways to promote timely deactivation discussions and foster better patient-centered, end-of-life care practices for people with ICDs.”

The Results
The systematic review included articles published in peer-reviewed journals between January 1, 1999 and October 31, 2010.  The findings revealed:

  • Providers’ knowledge deficits related to functions and attitudes about ICD deactivation in terminally ill patients can adversely affect the timing of deactivation discussions.
  • Providers’ reluctance to discuss deactivation may stem in part from personal discomfort and lack of experience with this option.
  • ICDs may be viewed differently from other life-sustaining measures.
  • Providers may feel ill prepared to initiate a discussion about deactivation with patients; some might prefer expert guidance or that others initiate such discussion.
  • There’s evidence that ICD deactivation is most often performed by an industry representative, and that continuity of care is lost.
  • Patients lack sufficient knowledge of ICD function to make informed decisions about deactivation.
  • Deactivation discussions occur more frequently when a formal institutional policy exists. ICD deactivation in terminally ill patients is more likely when deactivation is discussed as part of an interdisciplinary approach to care.

“It is critical that nurses take a more active role in supporting the patient’s right to be informed about the option of  ICD deactivation,” said Maureen Shawn Kennedy, MA, RN, editor-in-chief of  AJN. “Nurses can support these rights through conversations with patients, their families, physicians and palliative care experts and through research that will help create more educational programs and policies.”

About the  American Journal of Nursing   
The  American Journal of Nursing ( AJN) is the leading voice of nursing and the most established nursing journal in the world, since 1900 ( It has received more awards for editorial excellence and dissemination of information than any other nursing publication. It is published by Lippincott Williams & Wilkins (