Harvard Heart Letter

Ask the doctor: My defibrillator has never "fired." Should I keep it or have it taken out?

Q. One day while I was gardening, I either slipped, hit my head, and passed out, or I passed out, fell, and hit my head. Since we couldn't tell, my doctors recommended I get a defibrillator as "insurance" in case a heart rhythm problem was the cause. I have had the defibrillator for eight years now, and it has never gone off. The battery is almost done and my doctor wants to put in a new battery. At age 86, I'd rather not have the procedure, the routine checkups are a hassle, and all of this is expensive. Could I just let the battery run down, then either leave the device in place or have it taken out?

A. Your question about continued use of an implantable cardioverter-defibrillator (ICD) is an important one that patients and doctors across the country are grappling with.

In the early 2000s, ICDs were implanted mainly in people who had experienced the kind of life-threatening rhythm that can be stopped with an electrical shock. The most common types are ventricular tachycardia and ventricular fibrillation. Today, ICDs are often implanted in people who might develop such a rhythm, such as heart attack survivors or people with heart failure. This approach definitely saves lives. But in the majority of people who get an ICD, the device never needs to shock the heart.

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