Implantable cardioverter defibrillators (ICDs) are implanted in increasing numbers of patients with the aim of treating ventricular arrhythmias in high-risk patients and reducing their risk of dying. Individuals are also living longer with these devices. As a result, a greater number of patients with an ICD will deteriorate either with worsening cardiac failure, another non-cardiac condition or general frailty and will have a limited prognosis. Frequently, they will be cared for by non-cardiac teams who may be less familiar with ICDs. Therefore, to ensure the person receives high-quality end-of-life care, they should have the opportunity to consider and discuss the option to deactivate the shock function of their ICD. If the ICD shock therapy is not discontinued, there is an increased risk that, as a person reaches the last days of life, the ICD may deliver multiple, painful shocks that are distressing. There is also a risk that the device may delay the person’s natural death, which the person would not have chosen if they had been given the opportunity to discuss discontinuation. The British Heart Rhythm Society has developed a practical guideline to support all healthcare professionals who are caring for patients who have an ICD. This includes descriptions of different device types, ethical and legal aspects, timing and nature of ICD discussions and practical advice regarding how the devices may be deactivated. It aims to promote awareness and timely discussion between professionals and patients and to encourage best practice.

中文翻译：

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临终时停止植入式心律转复除颤器休克疗法：英国心律协会的共识指南


植入式心律转复除颤器 （ICD） 被植入越来越多的患者体内，目的是治疗高危患者的室性心律失常并降低他们的死亡风险。使用这些设备的人也活得更久。因此，更多的 ICD 患者会恶化，要么是心力衰竭恶化，要么是另一种非心脏疾病，要么是全身虚弱，预后有限。通常，他们将由可能不太熟悉 ICD 的非心脏团队照顾。因此，为了确保患者获得高质量的临终关怀，他们应该有机会考虑和讨论停用其 ICD 电击功能的选项。如果不停止 ICD 休克疗法，则随着一个人到达生命的最后几天，ICD 可能会带来多种令人痛苦的电击，从而增加风险。该设备还存在延迟该人自然死亡的风险，如果有机会讨论停药，该人不会选择自然死亡。英国心律协会制定了一项实用指南，以支持所有照顾 ICD 患者的医疗保健专业人员。这包括对不同器械类型的描述、道德和法律方面、ICD 讨论的时间和性质，以及关于如何停用器械的实用建议。它旨在提高专业人员和患者之间的意识和及时讨论，并鼓励最佳实践。