Conversion, Compromise, and Conversation—Moving to a Sensible Middle When Addressing Implantable Cardioverter-Defibrillator Therapy

To the Editor The Viewpoint by Kramer et al¹ titled “Facilitating Conversion of Implantable Cardioverter-Defibrillator Therapy to Pacing Only—Time to Adapt” is quite welcome. The authors note the many complexities and implications encountered at pulse generator (PG) change out when moving from an implantable cardioverter-defibrillator to a pacing system without tachyarrhythmia therapies. As Kramer et al¹ note, development of “life-limiting conditions or a decline in quality of life” may motivate such considerations. The patient’s desire to not receive any (or further) shocks may also drive this decision irrespective of any change in health status of the patient. Honoring the goals of shared decision-making clearly are of paramount importance when considering the option to continue or omit tachyarrhythmia therapies.