Verantwortlicher Umgang mit ICDs. Stellungnahme der Deutschen Gesellschaft für Kardiologie und ihrer Schwester-Gesellschaften

Responsible handling of ICDs Statement of the German Society of Cardiology and sister societies Abstract An increasing number of patients receive small implantable cardioverter/defibrillators (ICDs) embedded under their skin so as to prevent potentially life-threatening cardiac arrhythmias. As beneficial as these devices may be, they can also trigger problems, particularly when patients approach the end of life independent of their concomitant heart disease. In such cases, often many years after the initial implantation, ICDs may burden patients by unwanted shocks and by prolonging the process of dying. Fortunately, these problems can be eliminated by an ICD deactivation from outside, based on the patient’s (presumed) consent. Treating physicians, however, must be well acquainted with both the technical feasibility and equipment as well as the legal and ethical permissibility of such deactivations. Moreover, it is within the physicians’ responsibility to inform patients about these problems and their possible handling by an ICD directive in the context of advance care planning. The following report provides a systematic analysis of the aforementioned aspects as well as practical recommendations.