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Revised Deactivation of Implantable Cardiac Defibrillators at End of Life

The Agency for Clinical Innovation is now seeking feedback on the revised NSW Health Guideline on Deactivation of Implantable Cardiac Defibrillators at the End of Life. This document will replace the current guideline (2014).

Implantable Cardioverter Defibrillators (ICDs) are devices which are inserted to prevent sudden cardiac death from life-threatening arrhythmias. The device continuously monitors the electrical rate and rhythm in the heart and if certain arrhythmias are detected, a tachycardia therapy (either anti-tachycardia pacing (ATP) or a defibrillation ‘shock’) may be delivered to convert the heart into its usual rhythm.

When a patient with an ICD is in the terminal stages of their life, it may no longer be appropriate for the device to remain active and consideration should be given to program the device to a non-conversion therapy.

These guidelines have been revised in-line with contemporary evidence to standardise care across NSW. The document will assist clinicians to manage ATP and/or shock deactivation and facilitate a peaceful death for patients at the end of life, regardless of the life-limiting cause.

Could you please distribute the guideline to managers and clinicians working in areas where patinets with ICDs may be managed including (although not limited to) cardiology and stroke units, coronary care units, intensive care units, medical wards and Emergency Departments. Please provide feedback using the link below by Friday, XXXX

If staff have any queries about the guideline, please contact Bridie Carr at Bridie.Carr@health.nsw.gov.au or call 0437 035 984.

The objectives are:

  • to improve the care of patients with an ICD who are approaching the end of life by avoiding unwanted prolongation of life and the unnecessary distress associated with ICD activations
  • to inform and build capacity for conversations about deactivation of anti-tachycardia therapies between health care professionals and the patients and families in their care throughout the care continuum: at the initial discussion on implantation, during routine monitoring of the ICD, and at the end of life
  • to enhance considerations about ICD functions when planning and discussing an Advance Care Directive, including development of a resuscitation plan, a No CPR order and the use of an end of life care pathway
  • to promote regular assessment and review of patients with an ICD and the appropriateness of that device therapy across all health settings, where there is either a deteriorating cardiac disease or another life-limiting illness
  • to inform local best practice policy and protocol development for the deactivation of ICD anti-tachycardia therapies in hospital and community settings that consider local contexts, equipment and support needs
  • to inform recommendations for patient information, professional education and broader health care policy.

This form is accessible via distributed link.