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Phantom shocks in implantable cardioverter-defibrillator recipients: impact of education level, anxiety, and depression

Phantomschocks bei Patienten mit implantierbarem Kardioverter-Defibrillator: Einfluss von Bildungsniveau, Angst und Depression

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Abstract

Background

Implantable cardioverter defibrillators (ICDs) are designed to deliver shocks in the event of ventricular arrhythmias. Some ICD recipients experience the sensation of ICD discharge in the absence of an actual discharge (phantom shock, PS).

Objectives

The aim of this study was to evaluate the incidence, predictors, and consequences of PS in ICD recipients.

Materials and methods

Consecutive ICD recipients were examined during a routine outpatient follow-up (FU) visit. Subjects completed a written survey; their level of depression and anxiety was assessed with the hospital anxiety and depression scale (HADS). Quality of life (QOL) was assessed using the Minnesota living with heart failure questionnaire.

Results

Of 434 patients invited to the study, 423 (97.5%) ICD recipients agreed to and completed the survey; 349 (83%) had a primary prevention indication and 339 (80%) ischemic cardiomyopathy. A total of 27 patients (6.4%) reported a PS during a mean FU of 64 ± 44 months (5.4% in the primary prevention group and 10.8% in the secondary prevention group; p = 0.11). PS were related to higher education (≥bachelor’s degree 41% versus 20%; p = 0.03), and more frequent in patients receiving adequate shocks during FU (34% versus 0.5%; p < 0.001). HADS score levels were higher following PS (15 ± 6 versus 8.8 ± 7.4; p < 0.001). The majority of patients reporting PS felt that the information provided to them prior to ICD placement was insufficient (22.2% versus 5.0%), that they needed psychological support after ICD implantation (26% versus 3%), and considered ICD deactivation in near end-of-life situations (59% versus 29%; p < 0.001 for all).

Conclusions

PS occur in 6.4% of all ICD recipients and are related to higher education and to patients that experienced adequate shocks during FU.

Zusammenfassung

Hintergrund

Implantierbare Kardioverter-Defibrillatoren (ICD) wurden entwickelt, um bei ventrikulären Arrhythmien Schocks abzugeben. Einige Patienten mit ICD empfinden subjektiv eine solche Schockabgabe, ohne dass diese tatsächlich stattgefunden hat (Phantomschock [PS]).

Fragestellung

Ziel der Untersuchung war es, die Inzidenz, Prädiktoren und Folgen von PS bei Patienten mit ICD zu analysieren.

Material und Methoden

Konsekutive ICD-Patienten der Device-Ambulanz wurden eingeschlossen und im Rahmen eines routinemäßigen Follow-up(FU)-Termins untersucht. Die Patienten füllten einen Fragebogen aus, ihr Depressions- und Angstlevel wurde mithilfe der Hospital Anxiety and Depression Scale (HADS) untersucht. Die Lebensqualität wurde mithilfe des Minnesota Living with Heart Failure Questionnaire evaluiert.

Ergebnisse

Von den 434 eingeladenen Patienten waren 423 (97,5 %) zur Teilnahme bereit. Bei 349 (83 %) war Primärprophylaxe die ICD-Indikation, 339 (80 %) hatten eine ischämische Kardiomyopathie. 27 Patienten (6,4 %) berichteten einen PS während des mittleren FU von 64 ± 44 Monaten (5,4 % in der primärpräventiven und 10,8 % in der sekundärpräventiven Gruppe; p = 0,11). PS waren mit einem höheren Bildungsniveau assoziiert (≥ Bachelorabschluss 41 % vs. 20 %; p = 0,03) und traten häufiger bei Patienten mit adäquaten Schocks im Laufe des FU auf (34 % vs. 0,5 %; p < 0,001). HADS-Score-Werte waren signifikant höher nach PS (15 ± 6 vs. 8,8 ± 7,4; p < 0,001). Patienten mit PS waren häufiger mit den präoperativen Informationen unzufrieden (22,2 % vs. 5,0 %), benötigten häufiger psychologische Betreuung (26 % vs. 3 %) und zogen häufiger eine ICD-Deaktivierung am Lebensende in Betracht (59 % vs. 29 %; p < 0,001 für alle).

Zusammenfassung

PS treten bei 6,4 % aller Patienten mit ICD auf und hängen mit einem höheren Bildungsniveau und der Erfahrung von adäquaten Schocks während des FU zusammen.

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Acknowledgements

The authors would like to acknowledge the valuable work of the CIED nursing team: Christine Feser and Anne Hasch.

Funding

The authors declare that there are no relationships relevant to the contents of this paper to disclose. There was no relationship with the industry.

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Authors and Affiliations

  1. Division of Internal Medicine I, Klinikum Wernigerode, Wernigerode, Germany

    Swaroop Varghese

  2. Division of Invasive and Interventional Electrophysiology, Zentralklinik, Bad Berka, Germany

    J. Christoph Geller

  3. Division of Cardiology, Zentralklinik, Robert-Koch-Allee 9, 99438, Bad Berka, Germany

    Marc-Alexander Ohlow

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  1. Swaroop Varghese
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Correspondence to Marc-Alexander Ohlow.

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S. Varghese, J. C. Geller and M.-A. Ohlow declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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Varghese, S., Geller, J.C. & Ohlow, MA. Phantom shocks in implantable cardioverter-defibrillator recipients: impact of education level, anxiety, and depression. Herzschr Elektrophys 30, 306–312 (2019). https://doi.org/10.1007/s00399-019-00645-y

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