Psychophysiologic and Affective Parameters Associated With Pain Intensity of Cardiac Cardioverter Defibrillator Shock Discharges

Abstract

Augmented PPC of ICD shocks is predominantly associated with the number of perceived shocks, postshock anxiety, and accompanied by heightened levels of EMG magnitude and impaired EMG habituation, which points to sensitization of central neural structures.

Risk of Ventricular Arrhythmia After Implantable Defibrillator Treatment in Anxious Type D Patients

“…Screening for anxiety and Type D personality may be standardized in clinical practice because both factors have been associated with adverse outcomes in ICD patients (14,17,19,57,58). A recent review indicates that cognitivebehavioral therapy paired with exercise training may be most useful to diminish anxiety symptoms in ICD patients (59).…”

Psychopathology in postinfarction patients implanted with cardioverter-defibrillators for secondary prevention. A cross-sectional, case-controlled study

“…The nature of the anxiety in this group of patients has been reported previously [29]. Typical symptoms include generalized anxiety-palpitations, sweating, tremor, abdominal churning, and restlessness, sometimes accompanied by phobic anxiety symptoms and agoraphobia [29,30]. Panic symptoms with hyperventilation, paraesthesia, palpitation, difficulty in breathing, and chest pain are often precipitated by thoughts about further shocks and imminent death.…”

“…Also controversial is whether rehabilitation should be prophylactic for all ICD recipients or deployed more selectively-after receipt of shock therapy, for example [20,39]. However, it is already clear that psychological outcomes can be improved by a range of interventions [27][28][29][30][31][38][39][40].…”

Tetanizing prepulse: A novel strategy to mitigate implantable cardioverter-defibrillator shock-related pain

“…11,13,18–21 Shock warning systems were developed in conjunction with biphasic shocks because uncertainty of when a shock would occur was a common stressor, 22 but the psychological effect of expectation has been shown to worsen the perception of shocks. 23,24 Further, additional shocks given within minutes tend to hurt more than initial shocks. 11,12 Another pain reduction attempt used pre-pulses that were shown to reduce the pain perception associated with defibrillation-like shocks due to the suppression of activity within a ‘startle’ neural circuit, 25,26 but proof of clinical efficacy has not been shown.…”