Deactivation of cardiac implantable electronic devices in palliative patients: When and how.

Autor:	Oliveira T; Internal Medicine Unit, Department of Medicine, Cascais Hospital Dr. José de Almeida, Cascais, Portugal. Electronic address: tattiana.pm.oliveira@gmail.com., Ferreira Monteiro N; Internal Medicine Unit, Department of Medicine, Cascais Hospital Dr. José de Almeida, Cascais, Portugal., Cipriano P; Internal Medicine Unit, Department of Medicine, Cascais Hospital Dr. José de Almeida, Cascais, Portugal.
Jazyk:	English; Spanish; Castilian
Zdroj:	Medicina clinica [Med Clin (Barc)] 2024 Nov 29; Vol. 163 (10), pp. 512-516. Date of Electronic Publication: 2024 Jul 14.
DOI:	10.1016/j.medcli.2024.04.029
Abstrakt:	Cardiac implantable electronic devices have transformed medicine as they improve quality of life and prevent premature death. In palliative care settings, deactivation of these devices must be discussed, particularly at end-of-life. In terminally ill patients it is consensual to recommend implantable cardioverter defibrillator deactivation once shocks are frequent and painful. Concerning pacemakers, the decision to deactivate is controversial and it usually is not an option at patients' end-of-life, since in pacing-dependent patients, such low heart rates might induce symptoms of bradycardia, with no impact on survival. Regarding cardiac resynchronization therapy, deactivation is not recommended as it can worsen symptoms. Left ventricular assistance device deactivation at end-of-life is a well-accepted practice, since it has the benefit of ending the physical burden associated with the device. Advance care planning should be encouraged and patients should be informed that deactivation is possible. (Published by Elsevier España, S.L.U.)
Databáze:	MEDLINE
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