Melanie Foisy

Melanie Foisy is a long time Cardiac and Critical Care Nurse with a passion for cardiac devices. Research interests include MRI with cardiac devices and Nurse monitoring of heart failure diagnostic data and its potential to impact outcomes.


Title: 4D Project: Deactivation of Implantable Cardioverter-Defibrillators at a Distance for the Dignity of Dying

Abstract: BACKGROUND: Deactivation of implantable cardioverter-defibrillators in terminally ill patients can often be intrusive when patients are at their most vulnerable. Access to electrophysiologists or device specialists is limited. The current paradigm of deactivation involves transporting these patients to a clinic or other medical setting to conduct deactivation which can disrupt the dying process. We sought to demonstrate the feasibility of a novel method of ICD deactivation using remote programming and deactivation of anti-tachycardia pacing and defibrillation therapies allowing patients to remain in the location of their choosing.
METHODS: Single center, nonrandomized pilot study, including all patients with Medtronic defibrillators requesting deactivation, were considered for inclusion. After obtaining informed consent, a Medtronic device programmer equipped with RemoteView with RemoteControl software and cellular adaptor was transported to the patient’s location. A health care provider at the patient’s location received the equipment and set it up in proximity of the patient. A brief authenticated connection was created which allowed remote viewing and control of the programmer screen allowing for defibrillator deactivation.
RESULTS: This pilot study was completed per protocol in 5 out of 6 deactivation attempts. All 5 were successful in safely deactivating defibrillator therapies. One attempt was aborted due to a device programmer error and a routine deactivation was arranged.
CONCLUSION: Remote deactivation of ICD therapies is safe and effective in this small series of patients. Evaluation in a larger population is warranted given the significant benefits to patients with terminal illnesses who no longer desire prevention of sudden death.

 


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