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Comment & Response
July 31, 2019

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

Author Affiliations
  • 1Formerly Division of Cardiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
  • 2Cardiac Pacing & Tachyarrhythmia Devices, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
  • 3Cleveland Clinic Lerner College of Medicine, Department of Medicine, Case Western Reserve University, Cleveland, Ohio
JAMA Cardiol. Published online July 31, 2019. doi:10.1001/jamacardio.2019.2607

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.

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