Implantable Cardioverter Defibrillators in Heart Failure (2005-11-02)

Implantable Defibrillators in the Terminally Ill Aaron Trammell, MS4 UNC School of Medicine 11/13/2007

Case ,[object Object],[object Object],Braun TC, Hagen NA, Hatfield RE, Wyse DG. Cardiac pacemakers and implantable defibrillators in terminal care. J Pain Symptom Manage. Aug 1999;18(2):126-131.

Scope of the Problem ,[object Object],[object Object],[object Object],[object Object],[object Object],Mueller PS, Hook CC, Hayes DL. Ethical analysis of withdrawal of pacemaker or implantable cardioverter-defibrillator support at the end of life. Mayo Clin Proc. Aug 2003;78(8):959-963. Lewis WR, Luebke DL, Johnson NJ, Harrington MD, Costantini O, Aulisio MP. Withdrawing implantable defibrillator shock therapy in terminally ill patients. Am J Med. Oct 2006;119(10):892-896.

So Many ICDs for a Reason Josephson M, Wellens HJ. Implantable defibrillators and sudden cardiac death. Circulation . Jun 8 2004;109(22):2685-2691.

Ethical Dilemma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Disabling an ICD or Pacemaker ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Goldstein NE, Lampert R, Bradley E, Lynn J, Krumholz HM. Management of implantable cardioverter defibrillators in end-of-life care. Ann Intern Med. Dec 7 2004;141(11):835-838.

Literature Review ,[object Object],[object Object],[object Object],[object Object],[object Object]

Secondary Prevention – AVID ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. The Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators. N Engl J Med. Nov 27 1997;337(22):1576-1583.

Primary Prevention – MADIT-II ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Moss AJ, Zareba W, Hall WJ, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. Mar 21 2002;346(12):877-883.

Primary Prevention – SCD-HeFT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bardy GH, Lee KL, Mark DB, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. Jan 20 2005;352(3):225-237.

Indications for ICD Placement ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Gregoratos G AJ, Epstein AE, Freedman RA, Hayes DL, Hlatky MA, Kerber RE, Naccarelli GV, Schoenfeld MH, Silka MJ, Winters SL. ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee on Pacemaker Implantation). 2002.

Study on Withdrawal of ICD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Lewis WR, Luebke DL, Johnson NJ, Harrington MD, Costantini O, Aulisio MP. Withdrawing implantable defibrillator shock therapy in terminally ill patients. Am J Med. Oct 2006;119(10):892-896.

Study on Withdrawal of ICD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Lewis WR, Luebke DL, Johnson NJ, Harrington MD, Costantini O, Aulisio MP. Withdrawing implantable defibrillator shock therapy in terminally ill patients. Am J Med. Oct 2006;119(10):892-896.

Recommended Steps for Requests ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Mueller PS, Hook CC, Hayes DL. Ethical analysis of withdrawal of pacemaker or implantable cardioverter-defibrillator support at the end of life. Mayo Clin Proc. Aug 2003;78(8):959-963.

Conclusions ,[object Object],[object Object],[object Object],[object Object],[object Object]

Other Thoughts ,[object Object],[object Object],[object Object],[object Object]

Pacemakers in the Terminally Ill ,[object Object],[object Object],[object Object],[object Object],[object Object]

References ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Implantable Cardioverter Defibrillators in Heart Failure (2005-11-02)

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Implantable Cardioverter Defibrillators in Heart Failure (2005-11-02)