Pacemaker implantation in patients with major depression, should it be of concern? A case report and literature review

Abstract

Background: Psychological adaptation after cardiac pacemaker implantation is a challenge for patients with mental illness. Case presentation: Here we report a self-harming patient with a psychiatric disorder. A 73-year-old female patient with 16-year coronary heart disease and a 4-year depression was admitted to our hospital for a coma. Two months earlier, the local hospital confirmed that the patient had a second-degree sinoatrial (SA) block (type 2) as well as basal septal hypertrophy with the left ventricular outflow obstruction. Therefore, metoprolol sustained-release tablets 95 mg QD and diltiazem sustained-release tablets 90 mg QD was given as treatment after a pacemaker was implanted. However, the patient had continued complaining about discomfort due to the pacemaker implanted after being discharged from the hospital. Two months later, she attempted to commit suicide by removing her pacemaker and taking 80 sleeping pills. After a series of treatments, the patient improved and was discharged without a pacemaker re-implantation. With continued anti-depression treatment and strengthen family supervision, the patient's condition is stable now. Conclusions: A suicide attempt by intentionally removing the permanent pacemaker system was rarely reported. In bradycardia patients with a history of psychological or psychiatric disease, careful evaluation should be done before and after implantation of the pacemaker.

Quality of life of patients with cardiac pacemaker: levels, associated characteristics, and the impact of anxiety and depression

“…Strikingly, suicide attempts by intentionally removing the pacemaker system are rare, but they have adverse clinical outcomes. 22 Apart from physical functioning and role physical in depression, all remaining QoL subscales were associated with anxiety and depression. The potential influence of anxiety and depression on QoL is a notable aspect in the field of PPM.…”

Persistent left superior vena cava in a patient with an implanted dual-chamber pacing system in atrial fibrillation with tachycardia-bradycardia syndrome

“…The developed weakness of the sinus node will be refl ected in a condition that is life-threatening. At this stage of the disease in the form of atrial fi brillation, it becomes necessary to use treatment methods that will maintain the sinus rhythm of the cardiac muscle at a stable level, both at rest and when performing optimal physical activity (12). As clinical experience shows, this condition cannot be achieved in a stable, compensated form at the phase of drug therapy.…”

Forensic, legal, and clinical aspects of deaths associated with implanted cardiac devices

“…Also, ethical aspects in end-of-life-scenarios [e.g., ( 53 , 54 )], or therapeutic aspects in accidental digoxin overdosing ( 55 ) are discussed in the literature. However, 8 articles deal with suicide attempts by targeting the aggregate and/or the leads ( 35 , 42 , 43 , 45 – 49 ). In one case report, the individual attempted suicide by jumping out of the window after PM implantation ( 35 ).…”

“…In one case report, the individual attempted suicide by jumping out of the window after PM implantation ( 35 ). In some instances, the individuals combine the PM removal attempt with intoxication [e.g., ( 43 , 46 , 48 )]. Only in one reported case no mental illness was known prior to the suicide attempt ( 35 ).…”