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Deactivation of implantable cardioverter-defibrillators in terminally ill patients at the end of life can often be intrusive when patients are at their most vulnerable. Access to electrophysiologists or device specialists is limited. The current paradigm of deactivation involves transporting these patients to a clinic or other medical setting to conduct deactivation which can disrupt the dignity of the dying process. We sought to demonstrate the feasibility of a novel method of ICD deactivation using remote programming and deactivation of anti-tachycardia pacing and defibrillation therapies and alarms to allow patients to remain in their chosen place of dying at the end of life.
Methods and Results
Single center, nonrandomized pilot study, including all patients with Medtronic defibrillators requesting deactivation, were considered for inclusion. After obtaining informed consent by patient or power of attorney, a customized Medtronic device programmer equipped with RemoteView, RemoteControl software and cellular adaptor was transported to the patient’s location (within or outside the Hospital). A health care provider at the patient’s location received the equipment and set it up in proximity of the patient. Once powered on, a brief authenticated connection was created which allowed remote viewing and control of the programmer parameter screen, with the electrophysiology team remaining at the clinic location. The electrophysiology team then deactivated defibrillator therapies and saved the session. This pilot study was completed per protocol in 5 out of 6 deactivation attempts. All 5 were successful in safely deactivating defibrillator therapies. One attempt was aborted due to a device programmer error occurring during the attempt to establish authenticated connection and a routine deactivation was arranged. The clinical characteristics, demographics, reason for deactivation and location of the 5 patients can be found in Table 1.
Conclusion
Remote deactivation of ICD therapies is safe and effective in this small proof-of-concept series of patients. Evaluation in a larger population is warranted given the significant benefits to patients with terminal illnesses who no longer desire prevention of sudden death.
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