[Device therapy in cardiological palliative care situations].

There is considerable uncertainty about the management of patients with cardiac implantable electronic devices (CIEDs) threatened by immediate or medium-term death due to heart failure or other disease, for patients and their relatives as well as for physicians and medical staff. Patients can be afraid that they cannot die as long as pacing persists; medical staff may forget to deactivate shock therapies in an agonal phase or may not know how to do this without a programmer. For optimal handling of CIEDs in a palliative care situation, patients have to be informed that pacemakers or cardiac resynchronization therapy have no life-prolonging effect in this situation but only limit suffering, particularly due to dyspnea. Palliative care physicians must be informed that ICDs can be temporarily deactivated by magnet application, requiring neither a device specialist nor a programmer. Medical staff has to be trained in empathic discussions about CIED deactivation. An optimal setting for this talk may occur if the patient asks about the course and prognosis of his disease or an advance directive, which includes statements about resuscitation. Palliative care physicians have to understand the different functions of a CIED (antibradycardia pacing, resynchronization, antitachycardia pacing, shock therapy) and the deactivation of each of these components to ensure an appropriate decision; otherwise, CIED management at the end of a patient's life may cause suffering and a sense of guilt in relatives and medical staff.