Changes in the Physical Function and Psychological Distress from Pre-Implant to 1, 6, and 12 Months Post-Implant in Patients Undergoing Implantable Cardioverter Defibrillator Therapy

Recipients of implantable cardioverter-defibrillator (ICD) therapy in Western countries often experience distressful physical and psychological adjustments. Sociocultural influences on post-implant recovery are likely; however, evidence from other ethnic/cultural backgrounds is lacking. This study aimed to examine the changes in physical function and psychological distress (anxiety and depressive symptoms) from pre-implant to one, six, and 12 months post-implant in Korean patients undergoing ICD therapy. A total of 34 patients underwent pre- to post-implant longitudinal assessments of physical and psychological function using mixed modeling procedures. Physical function significantly declined from pre-implant to one month post-implant (B = −10.05, p = 0.004) and then nearly returned to the pre-implant level at six months post-implant (B = 8.34, p = 0.028). This level of improvement continued through 12 months post-implant. In psychological distress, significant improvements were observed from pre-implant to one month (anxiety (B = −1.20, p = 0.020) and in depressive symptoms (B = −1.15, p = 0.037)), which then plateaued without significant changes from one to 12 months. We concluded that physical function recovery occurred six months post-implant, but function remained poor until 12 months post-implant. Psychological distress improved one month post-implant and it was maintained. Clinicians must provide more intensive interventions to improve long-term physical function after ICD therapy.

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Implantable cardioverter defibrillators: physical and psychosocial outcomes

American Journal of Critical Care ◽

10.4037/ajcc1997.6.6.445 ◽

1997 ◽

Vol 6 (6) ◽

pp. 445-451 ◽

Cited By ~ 25

Author(s):

JM Craney ◽

CL Mandle ◽

BH Munro ◽

S Rankin

Keyword(s):

Myocardial Infarction ◽

Psychological Distress ◽

Implantable Cardioverter Defibrillator ◽

Psychosocial Functioning ◽

Implantable Cardioverter Defibrillators ◽

Long Term Outcomes ◽

Physically Active ◽

Cardioverter Defibrillator ◽

Cardioverter Defibrillators

BACKGROUND: The long-term outcomes of living with an implantable cardioverter defibrillator are an important consideration in recovery. However, little is known about physical and psychosocial outcomes beyond 1 year after implantation. OBJECTIVE: To describe the long-term physical and psychosocial adaptation of persons who have had an implantable cardioverter defibrillator for approximately 2 years or more. METHODS: This nonexperimental cross-sectional study used telephone interviews to ascertain the responses of 80 recipients of implantable cardioverter defibrillators to physical and psychosocial questionnaires to explore the long-term outcomes of living with the devices. Subjects eligible for inclusion were selected from the files of an arrhythmia clinic. RESULTS: Hierarchical regression analysis showed that subjects who are not emotional are likely to be more physically active, especially if they are young and male, and that subjects who tend to be emotional are likely to be psychologically distressed and have poorer social and domestic adaptation. Furthermore, use of emotions was a positive predictor of psychological distress and poor social and domestic adaptation. Subjects reported the use of both emotion- and problem-focused coping. Subjects' scores on physical and psychosocial functioning were comparable to scores reported in the literature for patients who have had myocardial infarction or dysrhythmia. CONCLUSIONS: Emotional responses to distress were predictive of little physical activity and psychological distress. Furthermore, young recipients of implantable cardioverter defibrillators and men were predicted to be physically active. Persons who have had an implantable cardioverter defibrillator for approximately 2 years or more can anticipate that their physical and psychosocial functioning will be similar to that of patients who have myocardial infarction or dysrhythmia.

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Long-term follow-up of patients with tetralogy of Fallot and implantable cardioverter defibrillator

European Heart Journal ◽

10.1093/ehjci/ehaa946.0792 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

V Waldmann ◽

A Bouzeman ◽

G Duthoit ◽

R Koutbi ◽

F Bessiere ◽

...

Keyword(s):

Primary Prevention ◽

Secondary Prevention ◽

Heart Transplantation ◽

Implantable Cardioverter Defibrillator ◽

Tetralogy Of Fallot ◽

Icd Therapy ◽

Cardioverter Defibrillator ◽

Long Term Follow Up

Abstract Background Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease, and sudden cardiac death represents an important mode of death in these patients. Data evaluating the implantable cardioverter defibrillator (ICD) in this patient population remain scarce. Purpose We aimed to describe long-term follow-up of patients with TOF and ICD through a large nationwide registry. Methods Nationwide Registry including all TOF patients with an ICD initiated in 2010. The primary outcome was the first appropriate ICD therapy. Secondary outcomes included ICD-related complications, heart transplantation, and death. Clinical events were centrally adjudicated by a blinded committee. Cox proportional hazard models were used to identify predictors of appropriate ICD therapies and ICD-related complications. Results A total of 165 patients (mean age 42.2±13.3 years, 70.1% males) were included from 40 centers, including 104 (63.0%) in secondary prevention. During a median (IQR) follow-up of 6.8 (2.5–11.4) years, 78 (47.3%) patients received at least one appropriate ICD therapy, giving an annual incidence of 10.5% (7.1% and 12.5% in primary and secondary prevention, respectively, p=0.03). Overall, 71 (43.0%) patients presented with at least one complication, including inappropriate ICD shocks in 42 (25.5%) patients and lead/generator dysfunction in 36 (21.8%) patients. Among 61 (37.0%) primary prevention patients, the annual rate of appropriate ICD therapies was 4.1%, 5.3%, 9.5%, and 13.3% in patients with respectively no, one, two, or ≥ three guideline-recommended risk factors. In our cohort, QRS fragmentation was the only independent predictor of appropriate ICD therapies (HR 4.34, 95% CI 1.42–13.23), and its integration in a model with current criteria increased the area under the curve from 0.61 to 0.72 (p=0.006). No patient with left ventricular ejection fraction (LVEF) ≤35% without at least one other risk factor had appropriate ICD therapy. Patients with congestive heart failure and/or reduced LVEF had a higher risk of non-sudden death or heart transplantation (HR=11.01, 95% CI: 2.96–40.95). Conclusions Our findings demonstrate high rates of appropriate therapies in TOF patients with an ICD, including in primary prevention. The considerable long-term burden of ICD-related complications, however, underlines the need for careful candidate selection. A combination of easy-to-use criteria might improve risk stratification beyond low LVEF. Freedom from appropriate ICD therapy Funding Acknowledgement Type of funding source: None

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Long-Term Follow-Up of Patients With Tetralogy of Fallot and Implantable Cardioverter Defibrillator

Circulation ◽

10.1161/circulationaha.120.046745 ◽

2020 ◽

Vol 142 (17) ◽

pp. 1612-1622 ◽

Cited By ~ 2

Author(s):

Victor Waldmann ◽

Abdeslam Bouzeman ◽

Guillaume Duthoit ◽

Linda Koutbi ◽

Francis Bessiere ◽

...

Keyword(s):

Primary Prevention ◽

Secondary Prevention ◽

Heart Transplantation ◽

Implantable Cardioverter Defibrillator ◽

Tetralogy Of Fallot ◽

Icd Therapy ◽

Cardioverter Defibrillator ◽

Qrs Fragmentation

Background: Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease, and sudden cardiac death represents an important mode of death in these patients. Data evaluating the implantable cardioverter defibrillator (ICD) in this patient population remain scarce. Methods: A Nationwide French Registry including all patients with tetralogy of Fallot with an ICD was initiated in 2010 by the French Institute of Health and Medical Research. The primary time to event end point was the time from ICD implantation to first appropriate ICD therapy. Secondary outcomes included ICD-related complications, heart transplantation, and death. Clinical events were centrally adjudicated by a blinded committee. Results: A total of 165 patients (mean age, 42.2±13.3 years, 70.1% males) were included from 40 centers, including 104 (63.0%) in secondary prevention. During a median (interquartile range) follow-up of 6.8 (2.5–11.4) years, 78 (47.3%) patients received at least 1 appropriate ICD therapy. The annual incidence of the primary outcome was 10.5% (7.1% and 12.5% in primary and secondary prevention, respectively; P =0.03). Overall, 71 (43.0%) patients presented with at least 1 ICD complication, including inappropriate shocks in 42 (25.5%) patients and lead dysfunction in 36 (21.8%) patients. Among 61 (37.0%) patients in primary prevention, the annual rate of appropriate ICD therapies was 4.1%, 5.3%, 9.5%, and 13.3% in patients with, respectively, 0, 1, 2, or ≥3 guidelines-recommended risk factors. QRS fragmentation was the only independent predictor of appropriate ICD therapies (hazard ratio, 3.47 [95% CI, 1.19–10.11]), and its integration in a model with current criteria increased the 5-year time-dependent area under the curve from 0.68 to 0.81 ( P =0.006). Patients with congestive heart failure or reduced left ventricular ejection fraction had a higher risk of nonarrhythmic death or heart transplantation (hazard ratio, 11.01 [95% CI, 2.96–40.95]). Conclusions: Patients with tetralogy of Fallot and an ICD experience high rates of appropriate therapies, including those implanted in primary prevention. The considerable long-term burden of ICD-related complications, however, underlines the need for careful candidate selection. A combination of easy-to-use criteria including QRS fragmentation might improve risk stratification. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03837574.

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Long-term outcomes among a cohort of 4296 implantable cardioverter-defibrillator patients: insights from the UMBRELLA study

European Heart Journal ◽

10.1093/eurheartj/ehab724.0345 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

S Briongos Figuero ◽

A Garcia Alberola ◽

J Rubio ◽

J M Segura ◽

A Rodriguez ◽

...

Keyword(s):

Multivariate Analysis ◽

Heart Disease ◽

Implantable Cardioverter Defibrillator ◽

Remote Monitoring ◽

Lower Risk ◽

Left Ventricular ◽

Icd Therapy ◽

Cardioverter Defibrillator

Abstract Background Large observational real-world studies describing modern implantable cardioverter-defibrillator (ICD) populations with long-term follow-up are lacking. Purpose To assess the incidence of arrhythmias in a cohort of contemporary patients undergoing ICD implant from 2005 and 2017 and to analyze the arrhythmic risk and mortality according to their clinical profiles. Methods UMBRELLA (NTC01561144) is a prospective, multicentre, nationwide study of ICD patients followed by remote monitoring. All device information was automatically stored through the remote monitoring system and a blinded review of all the stored arrhythmic episodes was performed. The study outcomes were first appropriate ICD therapy and all-cause death. Results The study population consisted of 4296 patients (61.9±12.9 years, ischaemic cardiomyopathy (ICM): n=2150, dilated cardiomyopathy (DCM): n=1166, valvular heart disease (VHD): n=119, hypertrophic cardiomyopathy (HCM): n=294, arrhythmogenic right ventricular cardiomyopathy (ARVC): n=71, Brugada syndrome (BS): n=143, long QT syndrome (LQTS): n=43, and adult congenital heart disease (ACHD): n=60)). Primary prevention (PP) was the main indication (n=2758). During a mean follow-up of 46.6±27.3 months, 16,067 episodes of sustained ventricular arrhythmia (SVA) occurred in 1344 patients. Appropriate ICD therapy was delivered to 85.7% (n=13,767) episodes of SVA in 1173 patients (27.3% of population). A higher risk of first appropriate ICD therapy was observed in VHD (HR: 1.94, 95% CI: 1.43–2.62), ARVC (HR: 1.84, 95% CI: 1.28–2.66), ICM (HR: 1.51, 95% CI: 1.29–1.78), and DCM (HR: 1.28, 95% CI: 1.07–1.53) whereas patients with HCM (HR: 0.72, 95% CI: 0.54–0.96) and BS (HR: 0.25, 95% CI: 0.14–0.45) were at significantly lower risk (Figure 1A). In multivariate analysis (Table 1), age, gender, atrial fibrillation (AF), secondary prevention, LVEF ≤35%, and QRS width emerged as clinical predictors of appropriate ICD therapy, whereas CRT-D correlated with lower risk. An independently higher risk was found in DCM, VHD, and ARVC, and a lower risk in BS patients. At follow-up, 590 deaths (13.4% of population) were reported. Patients with ICM (HR 3.90, 95% CI: 2.58–5.90), DCM (HR 3.33, CI 95%: 2.18–5.10), and VHD (HR 3.97, CI 95%: 2.25–6.99) had worse prognoses and it was significantly better in BS patients (HR 0.11, 95% CI: 0.01–0.67, p=0.017) (Figure 1B). In multivariate analysis, age, gender, AF, renal failure, diabetes and reduced LVEF, emerged as independent predictors of all-cause death (Table 1). Conclusions Irrespective of the aetiology, contemporary ICD patients with an arrhythmic substrate derived from left ventricular systolic dysfunction had a similar risk of ICD life-saving interventions and death. FUNDunding Acknowledgement Type of funding sources: None. Table 1 Figure 1

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Psychological assessment of depression and anxiety in patients with implantable cardioverter-defibrillator: DEFibrillator-related distress and depression survey in Chiba 2

European Heart Journal ◽

10.1093/eurheartj/ehab724.2425 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

Y Kondo ◽

K Miyazawa ◽

M Nakano ◽

T Kajiyama ◽

M Nakano ◽

...

Keyword(s):

Risk Factors ◽

Psychological Distress ◽

Implantable Cardioverter Defibrillator ◽

Psychological Functioning ◽

Icd Implantation ◽

Factors Affecting ◽

Icd Therapy ◽

Cardioverter Defibrillator ◽

Increased Risk ◽

The Impact

Abstract Background Despite the established treatment for life-threatening arrhythmias, the implantable cardioverter-defibrillator (ICD) therapy has emerged as a major determinant of psychological distress. Previous studies have showed several approaches to assess the ICD-specific psychological distress, however, the risk factors affecting psychological functioning are relatively variable across studies, and are not well studied in Japanese population. Therefore, we prospectively investigate the risk factors affecting the psychological functioning and assess the impact of ICD therapy in Japanese patients with ICD. Methods We prospectively enrolled consecutive 136 patients in the present study. At the time of ICD implantation and 1 year later, all patients completed the Florida Shock Anxiety Scale (FSAS), which is a tool designed to provide a quantitative measure of ICD shock-related anxiety. In addition, patients were also examined by psychiatrists using two assessment scales, Montgomery-Åsberg Depression Rating Scale (MADRS) and Hospital Anxiety and Depression Scale (HADS). Results The FSAS score was significantly correlated with the MADRS and HADS scores (Figure). During 1-year follow-up, 11 patients (8.1%) received ICD therapy. Younger age was significantly associated with the FSAS and MADRS scores at registration, but ICD therapy was the only independent factor associated with the increased risk of the FSAS score at 1 year later (p-value = 0.012). Conclusions ICD therapy has a strong impact on psychological distress in time course of ICD implantation. To reduce unnecessary shock therapy and optimal intervention by healthcare professionals may lead to the improvement of ICD-related psychological functioning. FUNDunding Acknowledgement Type of funding sources: None. Figure 1. Correlation between MADRS and HADS score Figure 2. FSAS, MADRS and HADS scores

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