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April 17, 2019

Facilitating Conversion of Implantable Cardioverter-Defibrillator Therapy to Pacing Only—Time to Adapt

Author Affiliations
  • 1The Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
JAMA Cardiol. 2019;4(5):401-402. doi:10.1001/jamacardio.2019.0882

Patients with implantable cardioverter-defibrillators (ICDs) who develop life-limiting conditions or a decline in quality of life may no longer prioritize protection from ventricular arrhythmias, and they may wish to have their ICDs deactivated.1 Similarly, some patients with ICDs that are approaching the routine end of their battery life prefer not to receive a new device and will elect to have their device deactivated or removed.2 However, more than 40% of patients presenting for ICD replacement require pacing.3 In the past, ICD systems could be downgraded to only provide pacing by replacing the ICD generator with a pacemaker generator attached to the existing leads. Unfortunately, changes in ICD lead technology have made this impossible, specifically because there is no adaptor available to facilitate this simple, cost-effective, and patient-centered procedure. Addressing this problem should become a priority for payers, manufacturers, and clinicians engaged in the care of patients living with ICDs.

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