Implantable Defibrillator Therapy Before Death: High Risk for Painful Shocks at End of Life
Background—Several trials have demonstrated improved survival with Implantable Defibrillator (ICD) therapy. The cause and nature of death in the ICD population is insufficiently investigated. The objective of this study was to analyse ICDs from deceased patients to assess the incidence of ventricular tachyarrhythmias, the occurrence of shocks and possible device malfunction.
Methods and Results—We prospectively analysed intracardiac electrograms in 125 explanted ICDs. The incidence of ventricular tachyarrhythmia, including ventricular fibrillation, as well as shock treatment were assessed. Ventricular tachyarrhythmia occurred in 35% in the last hour; 24% had an arrhythmic storm and 31% received shock treatment during the last 24h. Arrhythmic death as the primary cause occurred in 13% of the patients and the most common cause of death was congestive heart failure (37%). More than half (52%) of the patients had a Do-Not-Resuscitate order, and 65% of them still had the ICD shock therapies activated 24h before death. Possible malfunction of the device were found in 3% of all patients.
Conclusions—More than a third of the patients had a ventricular tachyarrhythmia within the last hour of life. Cardiac death was the primary cause and heart failure the specific cause of death in the majority of the cases. Devices remained active in over half of the patients with a Do-Not-Resuscitate order; almost a fourth of these patients received at least one shock in the last 24 hours of life.
- Received March 22, 2013.
- Revision received October 4, 2013.
- Accepted October 15, 2013.