The Influence of Antiarrhythmic Device Intervention on Biopsychosocial Functioning and Anxiety in Patients with an Implanted Cardioverter Defibrillator

Background and objectives: The aim of the study was to assess the impact of cardioverter-defibrillator interventions on the psychosocial functioning of a patient and the occurrence of concerns related to ICD. Materials and Methods: The conducted study was a prospective and observational study that included 158 patients. The study was conducted in two stages: I before ICD implantation and II a follow-up visit six months after the ICD implantation. Standardized questionnaires were used in both stages. Results: In the first six months, a cardioverter-defibrillator discharge occurred in 28 participants, which constituted 17.72% of the study group. The number of ICD discharges positively correlated to insomnia, symptoms of anxiety, symptoms of depression, more discharges, more severe insomnia, anxiety and depression. There was also a negative correlation between the number of discharges and the degree of disease acceptance and in the quality of life domains: somatic, mental, social and environmental. The more discharges, the worse the disease acceptance and assessment of the quality of life. Conclusions: Individuals who experienced discharges assessed their quality of life as worse in all aspects (perception of the quality of life, own health, physical, mental, social and environmental domains), experienced anxiety and depressive disorders more often, were characterized by a worse functioning in a chronic disease, experienced insomnia more often and reported more concerns related to ICD implantation.

Outcomes of single- or dual-chamber implantable cardioverter defibrillator systems in Japanese patients

Background

There are no criteria for selecting single- or dual-chamber implantable cardioverter defibrillators (ICDs) in patients without a pacing indication. Recent reports showed no benefit of the dual-chamber system despite its preference in the United States. As data on ICD selection and respective outcomes in Japanese patients are scarce, we investigated trends regarding single- and dual-chamber ICD usage in Japan.

Methods

Data from a total of 205 ICD recipients with structural heart disease (median age, 63 years) in two Japanese university hospitals were reviewed. Patients with bradycardia with a pacing indication and permanent atrial fibrillation at implantation were excluded.

Results

Single- and dual-chamber ICDs were implanted in 36 (18%) and 169 (82%) patients, respectively. Non-ischemic cardiomyopathy dominated both groups. Seventeen dual-chamber patients developed atrial pacing-dependency over 4.5 years, and it developed immediately after implantation in 14. Although preoperative testing showed no sign of bradycardia in these patients, their pacing rate was set higher than it was in patients who were pacing-independent (61 vs. 46 paces per min, p<0.01). Two single-chamber patients (5%) underwent atrial lead insertion.

While inappropriate shock equally occurred in both groups (7 vs. 21 patients, single- vs. dual-chamber, P=0.285), device-related infection occurred only in dual-chamber patients (0 vs. 9 patients, P=0.155). No differences in death or heart failure hospitalization were observed between groups.

Conclusions

Dual-chamber ICDs were four-fold more common in Japanese patients without a pacing indication. No benefit over single-chamber ICD was observed. Newly developed atrial pacing-dependency seemed to be limited and could have been overestimated due to higher pacing rate settings in dual-chamber patients.

Programming implantable cardioverter/defibrillators and outcomes

Implantable cardioverter-defibrillators are complex technical devices with a multitude of programming options for the physician. In recent years, numerous randomized trials have been performed to define the optimal programming strategies and have provided valuable insights, especially in primary prevention patients. This article provides an actual overview on the existing evidence on the most important programming features for accurate detection and therapy of ventricular arrhythmias.