Cuidados paliativos y medicina

Abstracto

Considerations for the Deactivation of the Stimulation Function of Pacemakers and Defibrillators in End Stage Disease

Nägele Herbert, Groene E, Stierle D, Nägele MP

Background: The deactivation of anti-tachycardia functions of implantable cardiac devices such as pacemakers and defibrillators in end stage disease becomes clinical routine. Uncertainty exists about the deactivation of the stimulation function.

Methods: To collect information about possible consequences of the deactivation of stimulation we retrospectively analyzed device interrogation data of a total of 363 patients. 244 data stem from consecutive routine ambulatory patients and 119 from patients later died due to their chronic underlying illnesses.

Results: Routinely interrogated and later deceased patients are comparable for age at implantation (76.6 ± 9.4 vs 74 ± 7.7) and sex (females 26% vs 26%). Patients were divided in three groups: group A) no expected sequelae from deactivation (spontaneous heart rate >50/min, 51.5%), group B) expected reduced quality of life (spontaneous heart rate 30-50 or presence of cardiac resynchronization therapy; 34.7%) and group C) expected timely death (spontaneous heart rate<30; 13.8%). 

Discussion: According to our results only minorities of device patients (13.8%) are “truly” pacemaker dependent and were expected to die shortly after deactivation of stimulation (Group C). A third of patients may survive, but probably with a reduced quality of life either due to insufficient heart rate or loss of resynchronization (Group B). For more than a half of the patient’s deactivation of antibradycardia - stimulation seems to be irrelevant (Group A).  We conclude that the deactivation of the stimulation function of cardiac devices in palliative situations may be of lesser importance in the process of dying and may reduce quality of life.