Patient Acceptance of the Implantable Cardioverter Defibrillator in Ventricular Tachyarrhythmias

Abstract

Besides surgical problems, recipients of implantable cardioverter defibrillators (ICDs) are faced with psychological and social adjustments. Successful ICD therapy is influenced by the patients' perceived concerns regarding device, discharge, changes in life style, and complications. In order to assess patients' acceptance of the ICD, the psychological profile of 57 consecutive patients was evaluated using a specifically designed questionnaire and the State Trait Anxiety Inventory (STAI). The results showed that 20 patients stated fear of ICD discharge, 12 patients revealed physical discomfort due to the device, and limited quality-of-life occurred in 8 patients. Fifty-five of 57 patients answered that it was worth having an ICD device implanted, 30 (53%) patients returned to active life, and 56 (98%) would advise another patient to undergo implantation if necessary. Overall, there was only a slight, but insignificant, decrease in the level of anxiety within the total patient population after ICD implantation. However, a comparison of two subgroups indicated that the state of anxiety was significantly higher in patients < 50 years of age as well as in patients having received > 5 shocks versus those > 50 years of age and having experienced < 5 shocks. In general, the acceptance of the ICD as a tool in managing life-threatening ventricular tachyarrhythmias is high. Besides the increased survival rate, quality-of-life and patient acceptance are important criteria for successful ICD therapy.

2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing

“…With the advent and then dominance of primary prevention indications, avoidable shocks assumed a relatively larger proportion of total therapy [78][79][80][81][82][83]. Gradually, publications have increased awareness of the frequency and the diverse range of adverse outcomes associated with avoidable ICD therapy, and have demonstrated that avoidable ICD shocks can be reduced by evidence-based programming of the detection rate, detection duration, antitachycardia pacing (ATP), algorithms that discriminate supraventricular tachycardia (SVT) from VT, and specific programming to minimize the sensing of noise [81][82][83][84][85][86][87][88][89][90][91][92].…”

Unusual Cause of Inappropriate Implantable Cardioverter Defibrillators’ Shock: Tremor

“…Uygunsuz şok esnasında hastalar bilinçli olduklarından genellikle kötü tolere edilir. Ağrı, özellikle anksiyeteye neden olan psikolojik bozukluklar, ventriküler aritmi başlatabilme ve pil ömründe azalma olumsuz özellikleri arasında sayılabilir (5,6) . Uygunsuz ICD şoklamasının en yaygın nedenleri supraventriküler taşikar-disi (sinüs taşikardisi, atriyal fi brilasyon, atriyal fl atter) ve artefaktların aşırı algılanmasıdır.…”

Wpływ kardiowertera-defibrylatora na jakość życia — przegląd badań

“…[34] już w 1993 roku wykazali w grupie 57 pacjentów z ICD, że poziom lęku oceniany za pomocą State Trait Anxiety Inventory (STAI) był istotnie wyższy w grupie chorych, którzy doświadczyli więcej niż 5 interwencji wysokoenergetycznych. Z kolein w badaniu Johansen i wsp.…”

“…Pacjenci poniżej 50. roku życia w porównaniu ze starszymi chorymi wykazują wyższy poziom lęku [34], gorzej oceniają swoją QoL oraz podobnie jak chorzy, którzy doświadczyli interwencji wysokoenergetycznych ICD wyrażają więcej obaw takich jak strach przed wysiłkiem fizycznym, co może prowadzić do ograniczania aktywności życiowej w obawie przed sprowokowaniem kolejnej interwencji ICD [51].…”