{"title":"The implantable cardioverter-defibrillators at the end of life: a double-edged sword of a life-saving technology.","authors":"Giacomo Mugnai, Davide Genovese, Luca Tomasi, Alessia Gambaro, Flavio Ribichini","doi":"10.1016/j.tcm.2025.09.005","DOIUrl":null,"url":null,"abstract":"<p><p>Implantable cardioverter-defibrillators (ICDs) are critical for preventing sudden cardiac death, but their function poses a significant challenge in palliative care, where goals shift from life prolongation to comfort. A substantial percentage of patients receive painful, futile shocks in their final days, causing significant distress. This review synthesizes evidence on the impact of these shocks and underscores the gap between clinical practice and patient-centered care. Key barriers to timely ICD deactivation include clinician discomfort, patient misconceptions, and systemic flaws like fragmented care and absent institutional protocols. Although a robust ethical framework founded on patient autonomy supports deactivation in certain circumstances, its principles are poorly implemented. This review argues for a paradigm shift towards proactive, interdisciplinary care, calling for structured communication, routine advance care planning, and the integration of palliative cardiology models to ensure this life-saving technology does not compromise a dignified death.</p>","PeriodicalId":51199,"journal":{"name":"Trends in Cardiovascular Medicine","volume":" ","pages":""},"PeriodicalIF":9.0000,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Trends in Cardiovascular Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.tcm.2025.09.005","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Implantable cardioverter-defibrillators (ICDs) are critical for preventing sudden cardiac death, but their function poses a significant challenge in palliative care, where goals shift from life prolongation to comfort. A substantial percentage of patients receive painful, futile shocks in their final days, causing significant distress. This review synthesizes evidence on the impact of these shocks and underscores the gap between clinical practice and patient-centered care. Key barriers to timely ICD deactivation include clinician discomfort, patient misconceptions, and systemic flaws like fragmented care and absent institutional protocols. Although a robust ethical framework founded on patient autonomy supports deactivation in certain circumstances, its principles are poorly implemented. This review argues for a paradigm shift towards proactive, interdisciplinary care, calling for structured communication, routine advance care planning, and the integration of palliative cardiology models to ensure this life-saving technology does not compromise a dignified death.
期刊介绍:
Trends in Cardiovascular Medicine delivers comprehensive, state-of-the-art reviews of scientific advancements in cardiovascular medicine, penned and scrutinized by internationally renowned experts. The articles provide authoritative insights into various topics, encompassing basic mechanisms, diagnosis, treatment, and prognosis of heart and blood vessel disorders, catering to clinicians and basic scientists alike. The journal covers a wide spectrum of cardiology, offering profound insights into aspects ranging from arrhythmias to vasculopathies.