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How do patients with implantable cardiac defibrillators (ICDs) die? The answers have been elusive. Swedish researchers analyzed 125 ICDs removed from deceased patients and found that 38% of patients experienced a ventricular tachyarrhythmia in their last hour. In 97 cases the ICDs remained on during the last 24 hours of life, and 32% of patients received shocks, in some cases many. The majority (80%) of patients died in the hospital, and more than half had do-not-resuscitate (DNR) orders in their charts. Among those with DNR orders, half of the ICDs were still active one hour before death, leading the authors to write that such patients are still at risk for "unnecessary, possibly painful, shock despite progressive illness and imminent death." The results were reported online November 15, 2013, in Circulation.