Practical and Ethical Considerations in the Management of Pacemaker and Implantable Cardiac Defibrillator Devices in Terminally Ill Patients

Benjamin, Mina M.; Sorkness, Christine A.

doi:10.1080/08998280.2017.11929566

Cited by 5 publications

(3 citation statements)

References 10 publications

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“…Patients with capacity can refuse continued medical treatment and this includes cardiac pacemakers and defi brillators. 21 Deactivating the defi brillation function alone would allow pacing to continue but no therapeutic shocks would be delivered in the event of ventricular arrhythmia. It is important to ascertain the patient's underlying rhythm and disease process prior to deactivating a device, as this will allow an informed decision to take place.…”

Section: Patients Nearing the End Of Lifementioning

confidence: 99%

An Update on Cardiac Implantable Electronic Devices for the General Physician

Peal¹,

Mathews

Runnett

et al. 2018

Journal of the Royal College of Physicians of Edinburgh

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Cardiac electronic device implantation is a common and important intervention for patients with tachy- and bradyarrhythmia. An increasing number of patients are receiving more complex devices such as cardiac resynchronisation therapy or devices with a defibrillation function. Over the last 5 years, two new models of cardiac device have emerged, subcutaneous defibrillators and leadless pacemakers. With an ageing population and data demonstrating 2000 per 100,000 of the population aged over 75 years have a cardiac device, it is essential that the general physician remains updated on the common pacemaker indications and available therapies.

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Section: Patients Nearing the End Of Lifementioning

confidence: 99%

An Update on Cardiac Implantable Electronic Devices for the General Physician

Peal¹,

Mathews

Runnett

et al. 2018

Journal of the Royal College of Physicians of Edinburgh

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“…Approximately 1.4 million people in the US (2021) ( 1 , 2 ) have implanted ICDs and ~ 50% of these require an MRI scan over the course of their lifetime ( 3 , 4 ). While most patients with implanted ICDs can have diagnostic quality MRI studies in anatomical regions distant from the heart ( 4 , 5 ), a major portion of the population that require heart studies can have severely lower quality imaging studies ( 5–7 ).…”

Section: Introductionmentioning

confidence: 99%

Balanced-force shim system for correcting magnetic-field inhomogeneities in the heart due to implanted cardioverter defibrillators

Hrovat,

Kolandaivelu,

Wang

et al. 2024

Front. Med.

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BackgroundIn the US, 1.4 million people have implanted ICDs for reducing the risk of sudden death due to ventricular arrhythmias. Cardiac MRI (cMR) is of particular interest in the ICD patient population as cMR is the optimal imaging modality for distinguishing cardiac conditions that predispose to sudden death, and it is the best method to plan and guide therapy. However, all ICDs contain a ferromagnetic transformer which imposes a large inhomogeneous magnetic field in sections of the heart, creating large image voids that can mask important pathology. A shim system was devised to resolve these ICD issues. A shim coil system (CSS) that corrects ICD artifacts over a user-selected Region-of-Interest (ROI), was constructed and validated.MethodsA shim coil was constructed that can project a large magnetic field for distances of ~15 cm. The shim-coil can be positioned safely anywhere within the scanner bore. The CSS includes a cantilevered beam to hold the shim coil. Remotely controlled MR-conditional motors allow 2 mm-accuracy three-dimensional shim-coil position. The shim coil is located above the subjects and the imaging surface-coils. Interaction of the shim coil with the scanner’s gradients was eliminated with an amplifier that is in a constant current mode. Coupling with the scanners’ radio-frequency (rf) coils, was reduced with shielding, low-pass filters, and cable shield traps. Software, which utilizes magnetic field (B0) mapping of the ICD inhomogeneity, computes the optimal location for the shim coil and its corrective current. ECG gated single- and multiple-cardiac-phase 2D GRE and SSFP sequences, as well as 3D ECG-gated respiratory-navigated IR-GRE (LGE) sequences were tested in phantoms and N = 3 swine with overlaid ICDs.ResultsWith all cMR sequences, the system reduced artifacts from >100 ppm to <25 ppm inhomogeneity, which permitted imaging of the entire left ventricle in swine with ICD-related voids. Continuously acquired Gradient recalled echo or Steady State Free Precession images were used to interactively adjust the shim current and coil location.ConclusionThe shim system reduced large field inhomogeneities due to implanted ICDs and corrected most ICD-related image distortions. Externally-controlled motorized translation of the shim coil simplified its utilization, supporting an efficient cardiac MRI workflow.

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“…Several ethical analyses regarding ICDD have shown that it should not foster new moral issues. 9 , 10 , 11 , 12 Although withholding vs withdrawing therapies may appear to be equivalent ethically, 13 their psychological impacts may be viewed as different by some healthcare professionals and patients, 9 , 14 as shown in a qualitative patient focus group. 5 Patients viewed device deactivation as something special, 15 and this possibility was discussed with the professionals only very infrequently.…”

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confidence: 99%

Characteristics of Clinicians Are Associated With Their Beliefs About ICD Deactivation: Insight From the DECIDE-HF Study

et al. 2021

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Background Discussing goals of care with heart failure patients is recommended but is not done systematically, due to factors such as time and personal beliefs. A recent survey showed that one-fifth of clinicians believe that implantable cardioverter defibrillator deactivation (ICDD) is unethical or constitutes physician-assisted suicide. We investigated whether individuals’ characteristics are associated with these beliefs. Methods The Decision-Making About Goals of Care for Hospitalize d Pati e nts With H eart F ailure (DECIDE-HF) survey was given to healthcare providers at 9 hospitals to assess their perceived barriers to goals-of-care discussions. The association between respondent characteristics and their beliefs was examined using 2 adjusted logistic regression models. Results We included 760 clinicians (459 nurses, 94 fellows, and 207 cardiologists). The responses varied among professions, with the belief that ICDD is unethical considered to be important barrier by nurses (24%), fellows (10%), and staff (7%); P < 0.001). After adjusting for site, spirituality being more important in life (odds ratio [OR]: 2.21; 95% confidence interval [CI]:1.37-3.56; P = 0.001, compared to less important), region of training (Asia [OR: 5.88; 95% CI: 2.12-16.31; P = 0.001] and Middle East [OR: 5.55; 95% CI:1.57-19.63; P = 0.008] compared to Canada), and years in practice (OR: 1.32; 95% CI: 1.07-1.63; P = 0.01 per decade) influenced beliefs about ICDD being unethical, with similar results for the belief that ICDD represents physician-assisted suicide. Conclusions Sociocultural factors, region of training, and profession influence clinicians’ beliefs about ICDD being unethical and representing physician-assisted suicide. These factors and beliefs must be acknowledged when facing the delicate issue of end-of-life discussion.

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Practical and Ethical Considerations in the Management of Pacemaker and Implantable Cardiac Defibrillator Devices in Terminally Ill Patients

Cited by 5 publications

References 10 publications

An Update on Cardiac Implantable Electronic Devices for the General Physician

An Update on Cardiac Implantable Electronic Devices for the General Physician

Balanced-force shim system for correcting magnetic-field inhomogeneities in the heart due to implanted cardioverter defibrillators

Characteristics of Clinicians Are Associated With Their Beliefs About ICD Deactivation: Insight From the DECIDE-HF Study

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