Cardiac Implantable Electronic Devices (e.g. pacemakers, ICDs, loop recorders)
Patients with implantable devices require follow up in our cardiac physiology-led device clinics. Patients that have moved to Lothian or are lost to follow-up, please refer to General Cardiology and the referral will be directed to the most appropriate team. Cardiac device clinics take place at all sites across NHS Lothian.
End of Life Care
Patients with implantable devices (NOT pacemakers) who are approaching, or receiving, end of life care should be referred to Cardiology for discussion regarding switching off their device. This is to prevent the small possibility of the device resuscitating them inappropriately. Providing such a person with high-quality end-of-life care and allowing them a dignified death requires consideration and discussion of deactivation of the shock function of their ICD. When the ICD is not deactivated in this way the person may receive multiple painful or distressing shocks from the device during the last hours or days of their life. In some instances the device may delay the person’s natural death with shock delivery that the patient would not have chosen to receive if they had been given a chance to discuss deactivation.
Emergency and Out of Hours temporary deactivation
In an emergency setting/out of hours when a person is imminently dying; or if emergency surgery using diathermy is required (see perioperative SOP for pathway), the ICD should be temporarily deactivated by taping a ring magnet over the device. There are some other rare occurrences in secondary care when an ICD requires temporary deactivation, for example inappropriate shocks, but these will always have Cardiology involvement. Magnet application should only be used in an EMERGENCY until a device physiologist can reprogram the device to an appropriate mode.
If patient dies, the ring magnet MUST remain in place until device physiologist can permanently deactivate the device.
There are magnets available in various locations within RIE, WGH and SJH (On call Cardiology team should be contacted). There are also magnets available for emergency out of hours use in the community at St Columbus Hospice and Marie Curie Hospice.
C.W & C.S & H.L 11-09-23
Who to refer:
Patients with cardiac implantable electronic devices lost to follow up or new to Lothian.
Patients with implantable devices (NOT pacemakers) who are approaching, or receiving, end of life care.
How to refer:
Referrals should be sent via SCI gateway to the relevant hospital (site based on patient location – RIE, WGH or SJH) > General Cardiology and tick the appropriate box on the Sci Gateway form.
“Please tick box if this referral is for consideration of an implantable device (NOT pacemaker) to be switched off for end of life care.”
Doing so will alert the cardiologist triaging referrals to let the cardiac physiology team know about the patient.
In addition to the above please consider emailing the Cardiac Physiology department to ensure they are aware of the patient. Please use the following email address for this and for any enquiries: crm.rie@nhslothian.scot.nhs.uk
