Raphael Claire E, Koa-Wing Michael, Stain Nolan, Wright Ian, Francis Darrel P, Kanagaratnam Prapa
International Centre for Circulatory Health, Imperial College London and St Mary's Hospital, London, UK.
Pacing Clin Electrophysiol. 2011 Dec;34(12):1628-33. doi: 10.1111/j.1540-8159.2011.03223.x. Epub 2011 Sep 28.
Patients receiving implantable cardioverter-defibrillators (ICDs) often have severely impaired left ventricular function and a poor prognosis. Having an ICD in situ effectively denies them the possibility of a quick, arrhythmic death. It is still unclear if and when the end of life and device deactivation should be discussed with patients and how much patients want to know prior to ICD implantation.
Patients with an active ICD for chronic heart failure were interviewed regarding their attitude toward the ICD, their recollection of the consent procedure, and how they felt the end of life should be discussed with ICD patients (n = 54). Patients who had received ICD therapies (n = 25) were reviewed as a subgroup with extended questions regarding attitudes toward device deactivation.
Fifty-four patients were recruited. Most patients were not aware that the ICD could be deactivated. The vast majority of patients (84%) wanted to be involved in the deactivation decision; 40% felt this discussion should be prior to ICD implantation but others felt the discussion should only occur if the patient was terminally ill (16%) or in the last few days of life (5%).
Patients with ICDs are routinely counseled about the benefits of ICDs, but options for device deactivation are not well understood by patients. Most patients would like to be involved in deactivation decisions and we feel this should be discussed well in advance.
接受植入式心脏复律除颤器（ICD）治疗的患者通常左心室功能严重受损，预后较差。ICD的植入实际上使他们无法迅速死于心律失常。目前仍不清楚是否以及何时应与患者讨论生命末期和设备停用的问题，以及在植入ICD之前患者希望了解多少相关信息。
对患有慢性心力衰竭且ICD处于激活状态的患者进行访谈，了解他们对ICD的态度、对同意程序的回忆，以及他们认为应如何与ICD患者讨论生命末期问题（n = 54）。对接受过ICD治疗的患者（n = 25）作为一个亚组进行回顾，针对他们对设备停用的态度提出了更多问题。
招募了54名患者。大多数患者不知道ICD可以停用。绝大多数患者（84%）希望参与停用决策；40%的患者认为这种讨论应在植入ICD之前进行，但其他患者认为只有在患者处于绝症末期（16%）或生命的最后几天（5%）时才应进行讨论。
通常会向植入ICD的患者介绍ICD的益处，但患者对设备停用的选择了解不足。大多数患者希望参与停用决策，我们认为应提前进行充分讨论。
