10.3 Discussing Implantable Cardioverter Defibrillatior (ICD) deactivation An increasing number of people are undergoing an implantable Cardioverter Defibrillator (ICD) implantation, with or without Cardiac Resynchronisation Therapy (RCT). With the advent of ICDs the risk of sudden cardiac death has been reduced. However, maintaining these activities becomes undesirable towards the end stage of chronic heart failure when the patient s survival ceases to be the prime aim of treatment, and the target of therapy increasingly becomes the palliation of the symptoms. The point maybe reached when the potential benefits of an ICD are likely to be outweighed by their disadvantages. To deactivate the ICD is a major decision that ought to be taken after consideration of all major factors involved and in an open, informed, and inclusive manner. The timing of such a decision is a complex matter related to difficulties faced by health-care professionals in trying to determine where the patient is on the trajectory of chronic heart failure. Although a number of charities and professional bodies have written policies around the optimal timing of these discussions there is no consensus in clinical practice. Diverse views have also been expressed by people with heart failure and their families or carers about the implications of deactivation of ICDs. This diversity of views is further compounded by the different healthcare professionals involved and the different potential settings in which discussions can occur. This question looked to find evidence from the published literature as to what were the issues in this field and how these findings could be used to guide discussions about the timing of deactivation of defibrillators. 10.3.2 Review question: What criteria should determine when to discuss defibrillator deactivation? For full details see review protocol in appendix A. 