autonomy, ICD deactivation, ICD therapy, palliative care, sudden cardiac death



  1. Wiencek, Clareen PhD, RN, CNP, ACHPN
  2. Webster, Lisa BSN, RN, CHPN


The incidence of heart failure is increasing concurrent with the aging of the US population. Implantable cardioverter-defibrillators are becoming more prevalent in patients with heart failure and dysrhythmias. Therefore, palliative care settings are seeing an increasing number of patients with these devices. This case study examines issues related to one patient who choose to have his implantable cardioverter-defibrillator deactivated after being shocked numerous times in the intensive care unit setting. Consensus guidelines for implantable cardioverter-defibrillator implantation and deactivation are reviewed as nurses need to be prepared to provide evidence-based care of patients with these devices, support patient autonomy, and educate the patient and their family about the course of the process. Finally, this case study underscores the need for interdisciplinary preparation to deal with sudden cardiac death while providing emotional support for the patient's loved ones during and after the event.