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Phantom shocks unmasked: clinical data and proposed mechanism of memory reactivation of past traumatic shocks in patients with implantable cardioverter defibrillators

Journal of Interventional Cardiac Electrophysiology volume 34, pages 205–213 (2012)Cite this article

Abstract

Background

Implantable cardioverter defibrillators (ICD), despite an unequivocal clinical benefit, are known to have a complex psychosocial impact on the patients. ICD shocks and the resultant psychobiological changes are known to contribute to increased levels of anxiety, depression, and post-shock stress symptoms in these patients. Phantom shock is a patient-reported perception of an ICD shock in the absence of any actual shock; however, its pathophysiological understanding is poor.

Methods

A retrospective chart review of the University hospital ICD patients’ database from June 2006 to April 2010 was conducted. A total of 38 patients with documented phantom shocks as cases and 76 age- and sex-matched patients with no phantom shocks as controls were selected from the database. Patient characteristics were analyzed for their potential association with the occurrence of phantom shocks.

Results

Phantom shock patients had higher prevalence of documented depression (31.6%), anxiety (23.7%), and cocaine use (42.1%). Additionally, patients who had previous ICD shock storms were more likely to have phantom shocks (39.5%; p = 0.001). More importantly, no phantom shocks were reported in patients who did not receive defibrillation threshold testing or past ICD shock storms.

Conclusions

Phantom shocks are primarily observed in ICD patients who had prior exposure to traumatic device shocks and are more common in patients with a history of depression, anxiety, or substance abuse. A pathophysiological mechanism is proposed as a guide to potential prevention.

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Fig. 1
Fig. 2

Abbreviations

ICD:

Implantable cardioverter defibrillator

QoL:

Quality of life

PTSD:

Post-traumatic stress disorder

DFT:

Defibrillation threshold

OR:

Odds ratio

ULV:

Upper limit of vulnerability

HAT:

Hippocampo–amygdalo–thalamic

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Disclosures

Dr. Sears serves as a consultant to Medtronic and has or has had research grants from Medtronic and St. Jude Medical and has received speaker honorarium from Medtronic, Boston Scientific, St. Jude Medical, and Biotronik.

Author information

Affiliations

  1. Division of Cardiology/Electrophysiology, Wayne State University School of Medicine, Detroit, MI, USA

    Sony Jacob & Rajeev Aravindhakshan

  2. Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA

    Sidakpal S. Panaich & Sandip K. Zalawadiya

  3. Department of Anesthesiology, Wayne State University School of Medicine, Detroit, MI, USA

    George McKelvey & H. Michael Marsh

  4. Department of Clinical Psychiatry, Bryn Mawr Hospital, Philadelphia, PA, USA

    George Abraham

  5. Department of Psychology, East Carolina University, Greenville, NC, USA

    Samuel F. Sears

  6. Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA

    Samuel F. Sears

  7. Division of Cardiology/Electrophysiology, Department of Internal Medicine, University of Florida, Gainesville, FL, USA

    Jamie B. Conti

  8. Harper University Hospital, Wayne State University, 3990 John R, Detroit, MI, 48201, USA

    Sony Jacob

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  1. Sony Jacob
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  2. Sidakpal S. Panaich
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Correspondence to Sony Jacob.

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Jacob, S., Panaich, S.S., Zalawadiya, S.K. et al. Phantom shocks unmasked: clinical data and proposed mechanism of memory reactivation of past traumatic shocks in patients with implantable cardioverter defibrillators. J Interv Card Electrophysiol 34, 205–213 (2012). https://doi.org/10.1007/s10840-011-9640-7

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  • DOI: https://doi.org/10.1007/s10840-011-9640-7

Keywords

  • Phantom shocks
  • Implantable cardioverter defibrillator
  • Depression
  • Shock storms
  • DFT testing