Implantable Cardioverter-Defibrillators (ICDs) can deliver painful shocks in the last days or hours of life with no clinical benefit. ICD deactivation supports a peaceful, dignified death without affecting pacing functions.
Clinicians should identify patients with an ICD (whether for heart failure, cardiomyopathy, prior arrhythmia, or inherited arrhythmia syndromes) to ensure timely advance care planning discussions.
When to consider deactivation
- When a patient enters the last year or months of life, regardless of whether the terminal illness is cardiac
- This decision should be revisited at device checks, heart-failure reviews, and as part of advance care planning (ACP)
What planned deactivation involves
- Planned deactivation is arranged in advance via cardiology or ICD clinic (usually at the clinic that inserted the device)
- Performed by a cardiac physiologist; simple and painless
- Pacing continues (if present); only shock therapy is turned off
- Does not cause death
Practical points for clinicians
- Initiate and document conversations early, ideally within ACP and DNACPR discussions
- Ensure patient and family understand the purpose: avoiding unnecessary shocks, it is not about withdrawing care
- Undertakers will need confirmation that the device has been deactivated so documentation should be clear
If urgent deactivation is needed
- Emergency deactivation may be needed if the patient is receiving repeated painful shocks and immediate relief is required
- A doughnut magnet taped on the chest over the device will disable shocks as long as the magnet is in contact with the skin
- Formal deactivation by a cardiac physiologist is still needed