Remote ICD deactivation feasible in patients receiving comfort-based end-of-life care
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Key takeaways:
- Remote ICD deactivation for patients receiving hospice care was successful in a small feasibility study.
- Patients and family members reported high satisfaction with the process.
Remote deactivation of implantable cardioverter defibrillators was successful in patients transitioned to end-of-life care, with patients and family reporting high satisfaction with the protocol, researchers reported.
The results of ICD deactivation at distance for the dignity of dying — the 4D project — were published in a research letter in Circulation: Arrhythmia and Electrophysiology.
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“The need to transport patients who have chosen to focus on comfort to a clinic setting is suboptimal and out of line with their goals of care. We conducted an initial observational study at Queen’s University to assess current practices regarding ICD deactivation and found concerning issues,” Adrian Baranchuk, MD, FACC, FRCPC, FCCS, FSIAC, professor of medicine at Queen’s University in Kingston, Ontario, Canada, told Healio. “Two-thirds of patients died with active devices in place and the mean time to device deactivation after establishment of ‘do-not-resuscitate’ status was 38 days. Additionally, approximately 20% of patients received shocks in their last month of life, after a terminal diagnosis had been established.
“We subsequently designed an ICD remote deactivation protocol, where a reprogramming computer device was transported to the patient, and device reprogramming was performed remotely from the electrophysiologist’s office without the need to transport the patient to the clinic,” Baranchuk told Healio.
To assess the feasibility and safety of remote ICD deactivation protocol for patients transitioned to a comfort-focused end-of-life care, Alexander and colleagues tested a software (RemoteView and RemoteControl) developed in conjunction with Medtronic that gives clinicians the ability to view and make programming changes to ICD.
The researcher included six patients who transitioned to comfort-focused end-of-life care and requested ICD deactivation after Sept. 1, 2021.
The primary outcome was successful remote deactivation protocol without need for standard in-person device deactivation.
Physical safeguards were put in place to address any cybersecurity concerns with remote device deactivation.
A device programmer (Medtronic 2090) and internet fob were transported to the patient’s physical location and handed off to a patient surrogate who positioned the device, activated it, initiated a secure device connection and contacted a member of the electrophysiology team. The team member then disabled ICD shocks, antitachycardia pacing and associated alarms and confirmed successful deactivation via session synch.
The device programming computer was returned by messenger, cleaned per hospital policy and returned to secure storage.
Alexander and colleagues reported successful ICD deactivation in all six patients while leaving pacing functions intact, according to the study.
In this study, four of the patients were admitted to an acute care hospital while one was admitted to a hospice hospital and the other was at home.
“Although patients in the acute care hospital could have had their device deactivated by device clinic personnel in person, as a proof of concept of the feasibility of this approach to remote deactivation, patients underwent identical deactivation procedures irrespective of their physical location,” the researchers wrote.
Patients and family members reported high satisfaction with the remote ICD deactivation protocol, according to the study.
“This study showed that a remote approach is workable with current existing technology and it also provides support for the development of true remote reprogramming device capabilities in the future,” Baranchuk told Healio.
For more information:
Adrian Baranchuk, MD, FACC, FRCPC, FCCS, FSIAC, can be reached at adrian.baranchuk@kingstonhsc.ca.
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