Abstract
The experience of shock is the distinguishing feature for patients with implantable cardioverter defibrillators (ICDs) and is associated with diminished psychological functioning and quality of life. Multiple shocks and ICD storm are a relatively common event among patients with ICDs (10‐20%) and may present specific challenging medical and psychological management for the attending health care providers. This paper examines the medical and psychological aspects of ICD shocks and storms and describes a model of biopsychosocial management for patients following the experience of ICD storm. Successful management of patients post shock includes the use of antiarrhythmic medications and careful attention to the causality of the shocks via stored electrograms. The psychological management includes specific attention to debriefing post‐shock feelings and attributions, preventing avoidance behavior, and facilitating positive “return to life” actions. Preliminary research examining formal psychosocial treatment supports a cognitive behavioral strategy to reduce psychological distress and facilitate quality of life. Collectively, these data suggest that interdisciplinary management of patients with multiple ICD shocks or the experience of ICD storm is advised, and routine psychological consultation may be indicated for the patient post ICD storm to reduce the possibility of symptoms of post‐traumatic stress.
Keywords: implantable cardioverter defibrillator, psychosocial, ICD storm, shock management, traumatic stress
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References
- 1. Myerburg RJ, Castellanos A: Cardiac arrest and sudden cardiac death In Heart Disease: A Textbook of Cardiovascular Medicine, pp. 742–779 (Ed. Braunwald E.). Philadelphia, PA: W. B. Saunders, 1997. [Google Scholar]
- 2. Glikson M, Friedman PA: The implantable cardioverter defibrillator. Lancet 2001; 357: 1107–1117 [DOI] [PubMed] [Google Scholar]
- 3. Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, Daubert JP, Higgins SL, Brown MW, Andrews ML, The Multicenter Automatic Defibrillator Implantation Trial II Investigators: Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 2002; 346: 877–883 [DOI] [PubMed] [Google Scholar]
- 4. Sears SF, Eads A, Marhefka S, Sirois B, Urizar G, Todaro J, Sotile W, Curtis AB, Conti JB: The U. S. national survey of ICD recipients: Examining the global and specific aspects of quality of life (abstr). Eur Heart J 1999; 20: 232 10082156 [Google Scholar]
- 5. Conti CR: Prognosis after ICD implantation. Clin Cardiol 2001; 24: 699 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6. Kolata G: Extending life, defibrillators can prolong misery. New York Times 2002; 160:March 25, Section A, Page 1, Column 3 [PubMed] [Google Scholar]
- 7. Sotile WM, Sears SF: You can make a difference: Brief psychosocial interventions for ICD patients and their families. Minneapolis, Minn.: Medtronic, Inc., 1999. [Google Scholar]
- 8. Block M, Breithardt G: Long‐term follow‐up and clinical results of implantable cardioverter‐defibrillators In Cardiac Electrophysiology‐From Cell to Bedside, pp 1412–1425 (Eds. Zipes DP, Jalife J.). Philadelphia: W. B. Saunders, 1995. [Google Scholar]
- 9. Zipes DP, Roberts D, for the Pacemaker‐Cardioverter‐Defibrillator Investigators: Results of the international study of the implantable pacemaker car‐dioverter‐defibrillator : A comparison of epicardial and endocardial lead systems. Circulation 1995; 92: 59–65 [DOI] [PubMed] [Google Scholar]
- 10. Kowey PR, Levine JH, Herre JM, Pacifico A, Lindsay BD, Plumb VJ, Janosik DL, Kopelman HA, Scheinman MM: Randomized, double‐blind comparison of intravenous amiodarone and bretylium in the treatment of patients with recurrent, hemodynamically destabilizing ventricular tachycardia or fibrillation. Circulation 1995; 92: 3255–3263 [DOI] [PubMed] [Google Scholar]
- 11. Scheinman MM, Levine JH, Cannom DS, Friehling T, Kopelman HA, Chilson DA, Platia EV, Wilber DJ, Kowey PR: Dose‐ranging study of intravenous amiodarone in patients with life‐threatening ventricular tach‐yarrhythmias. Circulation 1995; 92: 3264–3272 [DOI] [PubMed] [Google Scholar]
- 12. Korte T, Jung W, Ostermann G, Walpert C, Lewalter T, Schneider C, Esmailzadeh B, Lüderitz B: Hospital readmission in patients with modern implantable cardioverter/defibrillator (abstr). Pacing Clin Electrophysiol 1997; 20: 1207 [Google Scholar]
- 13. O'Donoghue S, Platia EV, Waclawski S, Mispireta L: Transient electrical storm: Prognostic significance of very numerous automatic defibrillator discharges (abstr). J Am Coll Cardiol 1991; 17: 352A [Google Scholar]
- 14. Credner SC, Klingenheben T, Mauss O, Sticherling C, Hohnloser SH: Electrical storm in patients with transvenous implantable cardioverter‐defibrillators: Incidence, management and prognostic implications. J Am Coll Cardiol 1998; 32: 1909–1915 [DOI] [PubMed] [Google Scholar]
- 15. Exner DV, Pinski SL, Wyse DG, Renfroe EG, Follmann D, Gold M, Beckman KJ, Coromilas J, Lancaster S, Hallstrom AP: Electrical storm presages non‐sudden death: The Antiarrhythmics versus Implantable Defibrillators (AVID) Trial. Circulation 2001; 103: 2066–2071 [DOI] [PubMed] [Google Scholar]
- 16. Swerdlow CD, Schsls W, Dijkman B, Jung W, Sheth NV, Olson WH, Gunderson BD: Detection of atrial fibrillation and flutter by a dual‐chamber implantable cardioverter‐defibrillator. For the Worldwide Jewel AF Investigators. Circulation 2000; 101: 878–885 [DOI] [PubMed] [Google Scholar]
- 17. Arteaga WJ, Windle JR: The quality of life of patients with life threatening arrhythmias. Arch Intern Med 1995; 155: 2086–2091 [PubMed] [Google Scholar]
- 18. Konstam V, Colburn C, Butts L: Psychosocial adaptation of automatic implantable cardioverter defibrillator recipients: Implications for the rehabilitation counselor. J Appl Rehab Counseling 1995; 26: 19–22 [Google Scholar]
- 19. Sears SF, Todaro JF, Saia TL, Sotile W, Conti JB: Examining the psychosocial impact of implantable cardioverter defibrillators: A literature review. Clin Cardiol 1999; 22: 481–489 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20. Sears SF, Conti J, Curtis A, Saia TL, Foote R, Wen F: Affective distress and implantable cardioverter defibrillators: Cases for psychological and behavioral interventions. Pacing Clin Electrophysiol 1999; 22: 1831–1834 [DOI] [PubMed] [Google Scholar]
- 21. Godemann F, Ahrens B, Behrens S, Berthold R, Gandor C, Lampe F, Linden M: Classical conditioning and dysfunctional cognitions in patients with panic disorder and agoraphobia treated with an implantable cardioverter defibrillator. Psychosom Med 2001; 63: 231–238 [DOI] [PubMed] [Google Scholar]
- 22. Namerow PB, Firth BR, Heywood GM, Windle JR, Parides MK: Quality of life six months after CABG surgery in patients randomized to ICD versus no ICD therapy: Findings from the CABG Patch Trial. Pacing Clin Electrophysiol 1999; 22: 1305–1313 [DOI] [PubMed] [Google Scholar]
- 23. Schron EB, Exner DV, Yao Q, Jenkins LS, Steinberg JS, Cook JR, Kutalek SP, Friedman PL, Bubien RS, Page RL, Powell J: Quality of life in the Antiarrhythmics versus Implantable Defibrillators Trial: Impact of therapy and influence of adverse symptoms and defibrillator shocks. Circulation 2002; 105: 589–594 [DOI] [PubMed] [Google Scholar]
- 24. Pauli P, Wiedemann G, Dengler W, Blaumann‐Benninghoff G, Kuhlkemp V: Anxiety in patients with an automatic implantable cardioverter defibrillator: What differentiates them from panic patients? Psychosom Med 1999; 61: 69–76 [DOI] [PubMed] [Google Scholar]
- 25. Dunbar SB, Kimble LP, Jenkins LS, Hawthorne M, Dudley W, Slemmons M, Langberg JJ: Association of mood disturbance and arrhythmia events in patients after cardioverter defibrillator implantation. Depress Anxiety 1999; 9: 163–168 [DOI] [PubMed] [Google Scholar]
- 26. Wolpe J, Plaud JJ: Pavlov's contributions to behavior therapy: The obvious and not so obvious. Am Psychol 1997; 52: 966–972 [DOI] [PubMed] [Google Scholar]
- 27. Peterson C, Seligman ME: Explanatory style and illness. J Personal 1987; 55: 237–265 [DOI] [PubMed] [Google Scholar]
- 28. Sears SF, Todaro JF, Urizar G, Saia TL, Sirois B, Wallace R, Sotile W, Curtis AB, Conti JB: Assessing the psychosocial impact of the ICD: A national survey of implantable cardioverter defibrillator health care providers. Pacing Clin Electrophysiol 2000; 23: 939–945 [DOI] [PubMed] [Google Scholar]
- 29. Sears SF, Burns JL, Handberg E, Sotile WM, Conti JB: Young at heart: Understanding the unique psychosocial adjustment of young ICD patients. Pacing Clin Electrophysiol 2001; 24: 1113–1117 [DOI] [PubMed] [Google Scholar]
- 30. Kohn CS, Petrucci RJ, Baessler C, Soto DM, Movsowitz C: The effect of psychological intervention on patients' long‐term adjustment to the ICD: A prospective study. Pacing Clin Electrophysiol 2000; 23: 450–456 [DOI] [PubMed] [Google Scholar]