Managing Implantable Cardioverter-Defibrillators at End-of-Life: Practical Challenges and Care Considerations

Research output: Contribution to journalReview articlepeer-review

6 Scopus citations


Implantable cardioverter-defibrillators (ICDs) monitor for and terminate malignant arrhythmias. Given their potential as a life-saving therapy, an increasing number of people receive an ICD every year, and a growing number are currently living with ICDs. However, cardiopulmonary arrest serves as the final common pathway of natural death, and the appropriate management of an ICD near the end-of-life is crucial to ensure that a patient's death is not marked by further suffering due to ICD shocks. The tenets of palliative care at the end-of-life include addressing any medical intervention that may preclude dying with dignity; thus, management of ICDs during this phase is necessary. Internists are at the forefront of discussions about end-of-life care, and are likely to find discussions about ICD care at the end-of-life particularly challenging. The present review addresses issues pertaining to ICDs near the end of a patient's life and their potential impact on dying patients and their families. A multidisciplinary, patient-centered approach can ensure that patients receive the maximum benefit from ICDs, without any unintended pain or suffering.

Original languageEnglish (US)
Pages (from-to)143-150
Number of pages8
JournalAmerican Journal of the Medical Sciences
Issue number2
StatePublished - Feb 2019


  • Goals of care
  • Informed decision-making
  • Palliative care

ASJC Scopus subject areas

  • Medicine(all)


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