Heather M. Ross, MS, APRN, NP
Potential Financial Conflicts of Interest: None disclosed.
Ross HM. Deactivating Implantable Cardioverter Defibrillators. Ann Intern Med. 2005;143:690. doi: 10.7326/0003-4819-143-9-200511010-00015
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Published: Ann Intern Med. 2005;143(9):690.
TO THE EDITOR:
Berger (1) raises the important issue of advances in technology outstripping advances in ethical decision-making practices. His comparison of implantable cardioverter defibrillator (ICD) deactivation with hemodialysis discontinuation is valuable in helping to clarify the issues inherent in decisions to remove active and invasive therapies. I am very concerned, however, about the parallel drawn between deactivation of an ICD and deactivation of a permanent pacemaker. The nature of implanted cardiac devices and their functions related to the dying process are inherently different and must be considered as such. An ICD delivers therapy to terminate a life-threatening arrhythmia by delivering a shock or overdrive pacing. This therapy is most often sensed by the patient and is typically associated with marked discomfort. Conversely, a permanent pacemaker, once implanted, is typically not sensed by the patient and acts to replace the natural electrophysiology of an intact cardiac conduction system.
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