The Adaptation to an Implantable Cardioverter Defibrillator in a Survivor of Sudden Death Due to Fatal Arrhythmia

Abstract

The purpose of this article was to explore the adaptation to an implantable cardioverter defibrillator (ICD) of a survivor of sudden death due to fatal arrhythmia. Owing to medical urgency, the case patient, a woman, did not have sufficient time to get prepared mentally. Therefore, the case had difficulty coping and ultimately rejected the ICD device. During the period of hospital care (November 10th to 19th, 2015), in-depth interview and clinical observation were used to obtain information from the case. The interview was transcribed and analyzed by repeated reading. The analysis found the following major post-ICD-implantation-associated health problems: confusion about the necessity of ICD, changes in body image due to ICD device implantation, and maladaptation in post-ICD daily life. In addition to providing ICD-related information and to strengthening her support system, we explored with the case the meanings of the ICD device in order to resolve her confusion. In addition, we recognized her perception regarding the ICD device without judgement and discussed the impact on her body of having the ICD. Concurrently, we encouraged the case to re-examine her self-value and life goals. In addition, we reconstructed the picture of the appearance of wound and made her realized the merit of the ICD. In terms of broader application, we hope that patients may learn to understand the worth and meanings of the ICD device and to restore positive attitudes with regard to body image. Furthermore, these interventions help encourage patients to re-examine their self-worth and goals and to internalize the ICD device, thereby minimizing the psychological impact of implantation. Ultimately, this case adapted well to the ICD device. Finally, we hope to share this experience as a reference for improving quality of care. These results may specifically help sudden death survivors to adapt to ICD implantation.