A pacemaker and an implantable cardioverter defibrillator (ICD) are medical devices that treat irregular heart rhythms, known as arrhythmias. They use electrical pulses to prompt the heart to beat normally and prevent sudden cardiac death. However, they have distinct functions and implications for patients and caregivers.
A pacemaker helps control abnormal heart rhythms by sending electrical impulses to the heart muscles for contraction and cardiac synchronization. It is primarily employed for patients suffering from bradycardia (decreased cardiac rate) or tachycardia (increased heart activity). It is often used for patients with a damaged natural pacemaking mechanism, such as aging, heart disease, or other cardiac disorders.
An ICD can detect and treat potentially severe cardiac arrest caused by ventricular fibrillation (irregular heartbeat in the lower chamber) or tachycardia (heart rate over 100 beats per minute). It can send an energy shock that resets an abnormal heartbeat. ICDs are often suggested for people who are either at risk of or recovering from cardiac arrest. They also serve as pacemakers, ensuring the heart maintains appropriate activity.
In this article, we will explain the differences between a pacemaker and an ICD, why pacemakers can and should be allowed to remain on, why ICDs should be turned off, and some resources for understanding the differences between pacemakers and ICDs. We hope this article will help you or your loved one understand these devices better and make informed decisions about their care.
What are the differences between a pacemaker and an ICD?
If you or your loved one have an irregular heart rhythm, known as an arrhythmia, your doctor may recommend a medical device to help your heart beat normally. Two main types of devices can treat arrhythmias: pacemakers and implantable cardioverter defibrillators (ICDs). Both devices are small, battery-powered machines implanted under your chest’s skin, usually near your collarbone. They are connected to your heart by thin wires called leads, which deliver electrical signals to your heart muscles.
However, pacemakers and ICDs have distinct functions and implications for your health and quality of life. Here are some of the key differences between them:
A pacemaker helps keep your heartbeat at a regular rate and rhythm. A pacemaker monitors your heart rate and sends electrical impulses to your heart when it beats too slowly (bradycardia) or too fast (tachycardia). A pacemaker can also help coordinate the contractions of your heart’s upper and lower chambers (cardiac resynchronization therapy). A pacemaker can improve your symptoms of fatigue, dizziness, shortness of breath, and fainting caused by a slow or irregular heartbeat. A pacemaker can also prevent your heart from stopping completely (cardiac arrest).
An ICD returns your heart to a normal rhythm when it beats dangerously fast or chaotically. An ICD can detect and treat life-threatening arrhythmias, such as ventricular fibrillation (VF) or ventricular tachycardia (VT), which can cause sudden cardiac death. An ICD can send a low-energy shock (pacing therapy) or a high-energy shock (defibrillation therapy) to your heart to restore a normal heartbeat. An ICD can also be a pacemaker if your heart beats too slowly. An ICD can save your life if you have a cardiac arrest, but it can also cause discomfort, anxiety, and emotional distress when it delivers a shock.
Both pacemakers and ICDs require regular follow-up visits with your doctor to check their function and battery life. Both devices can also interfere with certain electronic devices, such as cell phones, microwaves, and metal detectors, so you must be careful and follow your doctor’s instructions on avoiding or minimizing these interactions.
Why pacemakers should be allowed to remain on at the end of life
Pacemakers are devices that help keep the heart beating regularly. When someone is extremely sick and nearing the end of their life, pacemakers do not make their life last longer. They are like gentle helpers that do not stop the natural process of dying. Even if a person has a pacemaker, when they are close to passing away, their heart will stop beating naturally, and the pacemaker cannot change that. It’s important to know that pacemakers are meant to provide comfort and stability for the heart but do not prevent death. When someone is terminally ill, which means they have a profoundly severe illness that cannot be cured, the pacemaker does not interfere with the body’s natural way of shutting down. In these situations, turning off a pacemaker is usually only done if the person or their family wishes it because it can help avoid unnecessary discomfort. In essence, pacemakers do not make dying last longer for someone extremely ill. They are there to offer support but do not change the natural process of passing away. It’s essential to understand that even with a pacemaker, the body will follow its natural course when the time comes, and the pacemaker does not alter that journey.
Why ICDs Should Be Deactivated Before the Active Dying Stage
When someone is extremely sick and close to the end of their life, turning off a device called an Implantable Cardioverter-Defibrillator (ICD) can be helpful. This device usually prevents sudden heart problems in people with severe heart conditions. Turning off the ICD does not cause any pain, and it allows the person to pass away naturally without any extra interventions. One significant benefit of turning off the ICD is that it stops the device from giving shocks that can be distressing, especially when someone is extremely ill. These shocks can be uncomfortable and may not be helpful when a person is nearing the end of their life. By deactivating the ICD, it lets the person’s body follow its natural course without any unnecessary interventions. Turning off an ICD for someone who is terminally ill can bring comfort and peace. It ensures that the person’s last moments are as calm and distress-free as possible. Making this decision allows the person to have a more gentle and natural passing, aligning with their wishes for a peaceful end-of-life experience.
Conclusion
Patients and caregivers must understand the differences between pacemakers and Implantable Cardioverter Defibrillators (ICDs). Pacemakers help control abnormal heart rhythms by sending electrical impulses to the heart muscles, while ICDs can detect and treat severe cardiac issues like ventricular fibrillation. It’s important to know that pacemakers provide comfort and stability without prolonging life, allowing the natural dying process to unfold peacefully. On the other hand, deactivating an ICD in terminally ill patients can prevent distressing shocks and ensure a more comfortable end-of-life experience. By making informed decisions about these devices, patients and caregivers can navigate end-of-life care with compassion and respect, honoring the individual’s wishes for a peaceful journey.
