Sep. 24, 1999 GAINESVILLE, Fla.---Jon Duffey was waiting for a table at a restaurant when he began to experience dizziness and a fluttering sensation in his chest. He tried to speak but mustered only a few words before an implanted device sent an electrical shock to his heart to correct its abnormal rhythm.
Duffey saw a bright blue flash, every muscle in his body tensed and relaxed, then he melted to the floor. An implantable cardioverter defibrillator, or ICD, had stabilized his potentially fatal irregular heartbeat for the first time. The 51-year-old Tampa Bay area resident, who had dreaded the initial shock, later realized his extreme fear was unwarranted, and his apprehension subsided.
University of Florida psychologist Samuel Sears says most ICD patients cope surprisingly well with the shocks and knowledge that each one may have signified a brush with death. Sears studied the psychosocial affects of ICDs and will present findings Friday (9/24) at a meeting of the Heart Failure Society of America in San Francisco.
"The majority of people with ICDs - 80 to 90 percent - report acceptance of the device and a quality of life the same or better than before receiving the ICD," said Sears, an assistant professor in the department of clinical and health psychology at UF's College of Health Professions. "The most common psychological symptoms in patients who do have problems are ICD-specific fears, such as fear of shock or device malfunction, as well as depression and anxiety."
Sears says the ICD has proved to be a major medical success but warns that if a patient is having psychological difficulty adjusting to an ICD, the medical benefits can be undermined.
"Psychologists and cardiologists need to work closely together to identify and assist patients who are having problems and who may be at-risk, and to use psychosocial interventions and education to help ICD patients view the device as a help rather than a hurt," Sears said.
The same technology associated with anxiety in some ICD patients also offers life-saving benefits. In one recent clinical trial involving more than 2,200 cardiac patients at 85 medical centers in the United States and Canada, deaths were reduced by 74 percent in patients treated with ICDs, compared with those treated only with medication. ICD manufacturer Medtronic Inc. of Minneapolis estimates that more than 35,000 ICDs are implanted each year.
Sudden cardiac death, a condition in which unstable heart rhythms prevent the heart from pumping blood, claims the lives of 250,000 U.S. adults annually, according to the American Heart Association.
The ICD, first used in 1980, treats ventricular tachycardia or ventricular fibrillation, which are dangerously fast, irregular heartbeats that often result in sudden cardiac death. The battery-powered device, about the size and shape of a deck of cards, is implanted beneath the skin of the chest and attached to the heart's surface with one or two electrodes. The ICD constantly monitors the heartbeat; when it detects an abnormality, it delivers pacing pulses or a shock to correct it. The maximum charge varies but averages 750 volts, said UF cardiologist Dr. Jamie Conti. ICD patients frequently equate the feeling of the shock with being kicked in the chest by a horse.
Sears reviewed previous studies of the psychosocial impact on patients, then conducted a national survey examining patients' quality of life. The survey generated data from 260 health-care providers, 450 ICD patients and 375 spouses or significant others.
Sears says health-care professionals need to focus on the 10 to 20 percent of ICD patients who report a decrease in quality of life after receiving the device. Most at-risk are patients under 50 and/or those who experience "ICD storms" - more than three shocks in a 24-hour period. Sears says women also are more likely to report adjustment difficulties.
Not all younger ICD patients have trouble coping. Laura Johnson, a 21-year-old senior at UF, received an ICD three years ago after a cardiac arrest caused her to collapse while running.
"I've always been athletic, so I was concerned about how my condition and an ICD would change my lifestyle," Johnson said. "At first, I was scared of the shock, and I was a little nervous because I was always aware of what my heart was doing. But I didn't let it interfere with my life. I still run and remain very active. I see the ICD as a positive thing."
During the five years Duffey has had an ICD, the device has delivered six shocks; all were in the first two years. He received the ICD because of a life-threatening arrhythmia following a heart attack.
"My quality of life is much higher now than it was before the device," Duffey said. "I faced issues at first, such as the fear of the (shock), and also of driving with the ICD and what would happen if it fired while I was behind the wheel. But I've gotten past that and I'm able to lead a very normal life."
Duffey, who publishes an online newsletter for ICD patients and their family members, says two factors alleviated much of his anxiety: speaking with another ICD patient before his surgery - an opportunity provided by his cardiologist - and getting involved with support groups afterward.
Sears cautions that research on the psychosocial impact of ICDs still is in its early stages and that many studies present several limitations, such as small sample sizes and a lack of standardized assessment measures.
"Studying the psychosocial effects is beginning to help us understand the stressors ICD patients face," Sears said. "It helps us to identify who is at-risk for psychological complications and to develop interventions that complement medical treatment and optimize patients' quality of life."
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