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Discussion

ICD off but not pacer

Pt is 77 years old, CHF, COPD, Vascular Dementia, multiple TIAs and a laundry list of other things. Was put on hospice 4 weeks ago. Pt is declining. BP is dropping daily and the ICD has had a magnet placed over it in the home until they can get him to a dr. office to have it d/c'd. Question... he has a pacer component with the device and it is set at 60. Pulse is maintaining at 60 as BP is dropping. Will the pacer portion have to be cut off separately - magnet won't do it? He is a DNR as of New Years day per his choice. Pt has a long heart history with quad bypass, multiple stents and ablatia. Wondering for the family about the pacer portion and is it holding him here and he is suffering. Will it eventually stop or quit or what will happen. It's like being on a machine isn't it?

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    All the magnet does is set the pacemaker back to default settings. If the family wants it off completely EP would have to come in and turn it off. I've had patients that have been changed to CMO with their pacemaker still on, it's not going to really do much, once the heart stops, it stops. The pacemaker will continue to spike even though the heart isn't doing anything.

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    Michlynn is correct. A magnet will only turn off a defibrillator, as far as a pacemaker all companies have what is called a magnet rate that sets the rate to a certain range once it is placed. In most circumstances a doc will have to the one that will turn off the pacer function for legal reasons. A nurse nor a device rep can/will do it, and usually leave that up to an EP, Cardiologist, or family MD.

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    I have seen a St. Jude's rep turn off a defibrillator in the hospital setting, after receiving an order from the MD. It was kinda scary how quick and easy it was to do.

    Regarding the OP question of the pt suffering, fear not, you absolutely can die of cardiac arrest with a pacemaker (and even an ICD). I once had an older pt concerned about getting one bc she thought it meant she would never die, poor thing.

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