Defibrillator Recipients Research Articles

Perceived support from healthcare professionals, shock anxiety and post‐traumatic stress in implantable cardioverter defibrillator recipients

To investigate (1) the extent to which shock anxiety and perceived support from healthcare professionals are related to post-traumatic stress disease (PTSD) symptoms and (2) the extent to which perceived support from healthcare professionals moderates the relationship between shock anxiety and PTSD symptoms in implantable cardioverter defibrillator recipients. An additional aim was to describe the level of PTSD symptoms and perceptions of support from healthcare professionals. Studies examining PTSD symptoms among implantable cardioverter defibrillator recipients are still sparse. In addition, little is known about how perceived support from healthcare professionals is related to PTSD symptoms. Cross-sectional survey design. Recipients (n = 167) with implantable cardioverter defibrillator attending an outpatient device clinic completed questionnaires assessing shock anxiety, PTSD symptoms and perceived support from healthcare professionals. The results indicated that between ten and 15% of the recipients experienced moderate to severe symptoms of PTSD. Although a majority perceived constructive support from healthcare professionals, 12% perceived nonconstructive support. Regression analysis demonstrated that shock anxiety and perceived nonconstructive support from healthcare professionals had a statistically significant (p < 0·01) association with PTSD symptoms. Moreover, the results suggest that associations between shock anxiety and PTSD symptoms were significantly (p < 0·01) moderated by perceived nonconstructive support from healthcare professionals. Young age, short time since implantation and secondary prevention indication were also significantly associated with PTSD symptoms. The results indicate that nonconstructive support from healthcare professionals can increase the tendency to develop PTSD symptoms, particularly in those who experience shock anxiety. Healthcare professionals should pay more attention to the way in which they communicate information to the recipients during follow-up visits. Clinically based strategies and interventions targeting shock anxiety and PTSD symptoms should be carried out.

QTc duration and QRS fragmentation on baseline ECG relate to sustained ventricular tachyarrhythmia and sudden cardiac death in hypertrophic cardiomyopathy

Purpose: The presence of prolonged QTc and QRS fragmentation (fQRS) on baseline ECG was studied in patients with hypertrophic cardiomyopathy (HCM) and related with occurrence of ventricular tachyarrhythmias or sudden cardiac death (VTA/SCD). Methods: A total of 195 clinical HCM patients was studied (52±13 years, 61% male). On a standard 12-lead ECG, QTc duration was calculated by Bazett's formula; fQRS was defined as presence of various RSR' patterns, R or S notching and/or >1 additional R wave in any non-aVR lead in patients without pacing or typical (in)complete bundle branch block. Study endpoint comprised SCD or sustained VTA (tachycardia or fibrillation) documented on ECG or, in baseline implantable cardioverter defibrillator (ICD) recipients [n=58 (30%)], by appropriate ICD therapies (shock/ATP) for VTA. QT prolonging drug recipients were excluded. Results: After a median follow up of 5.7 years (IQR 2.7-9.1), 26 (13%) patients experienced VTA (n=22) or SCD (n=4). Kaplan-Meier time to survival free of VTA/SCD showed worse survival in patients with QTc≥440 ms (p=0.017) or fQRS in ≥3 territories (inferior, lateral, septal and/or anterior) (p=0.004) (Figure). Multivariate regression analysis showed that both QTc ≥440 ms (β=2.4, p=0.034, 95% CI 1.07-5.58) and fQRS in ≥3 territories (β=3.4, p=0.007 95% CI 1.54-14.9) were independently associated with VTA/SCD. Excluding secondary prevention ICD recipients (n=13), likelihood ratio test indicated that assessment of QTc and fQRS on top of conventional SCD risk factors provided incremental value to predict occurrence of VTA/SCD (p=0.034). ![Figure][1] Kaplan Meier survival curve. Conclusion: QTc duration and presence of fQRS relate to occurrence of VTA/SCD in HCM patients, independently of conventional SCD risk factors, and therefore may have an impact on preventive treatment strategies. [1]: pending:yes

The relationship between perceived support from healthcare professionals, shock anxiety and device acceptance in implantable cardioverter defibrillator recipients

Purpose: The recipients acceptance of the implantable cardioverter defibrillator (ICD) can be influenced by several factors. One factor is perceived support from healthcare professionals during regular follow-up visits. Another factor is shock anxiety, i.e. the recipients concerns and fear related to possible future shocks. However, little is known about the relationship between perceived support from healthcare professionals, shock anxiety and device acceptance among the recipients. The purpose of this study is 1) to investigate the extent to which shock anxiety and perceived support from healthcare professional support is related to device acceptance and 2) to determine to what degree perceived support from health care professional moderates the relationship between shock anxiety and device acceptance in ICD recipients. Methods: A cross-sectional study comprising recipients (N-167, 80% male, mean age = 64 years) attending an outpatient device clinic completed standardized and validated questionnaires assessing perceived support from healthcare professionals, shock anxiety (the Florida Shock Anxiety Scale) and device acceptance (the Florida Patient Acceptance Survey). Demographic and clinical data were collected by self-report and from medical records in September-October 2010. The statistical analyses included descriptive statistics and multiple regression analyses. Results: The descriptive results indicated that 84.4% of the recipients reported high device acceptance. Regression analysis demonstrated that constructive support from healthcare professionals was positively associated with device acceptance (p<0.05) and moderated the negative relationship between shock anxiety and device acceptance (p<0.05). Non-constructive support and shock anxiety were statistically negatively associated with device acceptance (p<0.01). Conclusions: Healthcare professionals represent a valuable constructive support system that can enhance device acceptance among ICD recipients, partly by preventing shock anxiety from leading to poor device acceptance. On the other hand, the findings suggest that non-constructive communication on the part of healthcare professionals could hinder device acceptance.

GW24-e0442 Inhibition of biventricular pacing due to oversensing of atrial fibrillation by a left ventricular lead: Interest of remote monitoring

ObjectivesAtrial oversensing by a ventricular lead may cause asystole in a pacemaker dependent patient or inappropriate shocks in an implanted cardioverter defibrillator recipient patient. In cardiac resynchronization therapy (CRT) devices...

Left Bundle Branch Block Predicts Better Survival in Women Than Men Receiving Cardiac Resynchronization Therapy: Long-Term Follow-Up of ∼145,000 Patients

The goal of this study was to test the hypothesis that in recipients of cardiac resynchronization therapy defibrillators (CRT-D), conventional left bundle branch block (LBBB) diagnosis predicts better survival in women than in men. New York Heart Association class I and II patients without LBBB do not benefit from CRT-D, and women have better survival after CRT-D than men. Separate analysis suggests that QRS duration thresholds for LBBB diagnosis differ according to sex, and conventional LBBB electrocardiographic criteria are falsely positive in men more frequently than in women. We analyzed Medicare records from 144,642 CRT-D recipients between 2002 and 2008 that were followed up for up to 90 months. Medicare billing data were used to determine age, sex, race, and comorbidities. Hazard ratios (HRs) were calculated to assess if conventional LBBB diagnosis had different prognostic significance according to sex. In univariate analysis, LBBB was associated with a 31% reduction in death in women (HR: 0.69 [95% confidence interval (CI): 0.67 to 0.71]) but only a 16% reduction in death in men (HR: 0.84 [95% CI: 0.82 to 0.85]). In multivariable analyses controlling for comorbidities, LBBB was associated with a 26% reduction in death in women (HR: 0.74 [95% CI: 0.71 to 0.77]) and a 15% reduction in death in men (HR: 0.85 [95% CI: 0.83 to 0.87]). A significant interaction (p < 0.0001) between sex and LBBB was seen. LBBB diagnosis is associated with greater survival in women than in men receiving CRT-D, and this discrepancy is not explained by differences in measured comorbidities. Possible explanations for this difference include that LBBB may have different prognostic significance according to sex or that LBBB diagnosis is more often false-positive in men compared with women.

Gender-specific differences in clinical outcome of primary prevention implantable cardioverter defibrillator recipients

ObjectiveTo assess differences in clinical outcome of implantable cardioverter-defibrillator (ICD) treatment in men and women.DesignProspective cohort study.SettingUniversity Medical Center.Patients1946 primary prevention ICD recipients (1528 (79%) men and 418 (21%) women)....

Suitability for subcutaneous defibrillator implantation: results based on data from routine clinical practice

ObjectiveTo assess the proportion of current implantable cardioverter defibrillator (ICD) recipients who would be suitable for a subcutaneous lead ICD (S-ICD).DesignA retrospective cohort study.SettingTertiary care facility in the Netherlands.PatientsAll patients...

Incidence and predictors of phantom shocks in implantable cardioverter defibrillator recipients

Implantable cardioverter defibrillators (ICDs) are designed to deliver shocks or antitachycardia pacing (ATP) in the event of ventricular arrhythmias. During follow-up, some ICD recipients experience the sensation of ICD discharge in the absence of an actual discharge (phantom shock). The aim of this study was to evaluate the incidence and predictors of phantom shocks in ICD recipients. Medical records of 629 consecutive patients with ischaemic or dilated cardiomyopathy and prior ICD implantation were studied. With a median follow-up of 35months, phantom shocks were reported by 5.1% of ICD recipients (5.7% in the primary prevention group and 3.7% for the secondary prevention group; p=NS). In the combined group of primary and secondary prevention, there were no significant predictors of the occurrence of phantom shocks. However, in the primary prevention group, phantom shocks were related to a history of atrial fibrillation (p=0.03) and NYHA class <III (p=0.05). In the secondary prevention group, there were no significant predictors for phantom shocks. Phantom shocks occur in approximately 5% of all ICD recipients. In primary prevention patients, a relation with a history of atrial fibrillation and NYHA class <III were significant predictors for the occurrence of phantom shocks. In the secondary prevention patients, no significant predictors were found.

Uncovering Phantom Shocks in Cardiac Patients with an Implantable Cardioverter Defibrillator

Implantable cardioverter defibrillator recipients sometimes report "phantom shocks" (PSs), defined as a reported shock lacking objective evidence. The aim of this study was to describe the subjective experience of PSs and their psychosocial correlates using a mixed methods approach. PS participants were matched on sex and age with individuals who received objective shocks only (OSO). Participants were interviewed and completed measures of posttraumatic stress disorder (PTSD Checklist-Civilian Version), depression and anxiety (Hospital Anxiety and Depression Scale), disease-specific distress (Cardiac Anxiety Questionnaire-CAQ), and social desirability (Socially Desirable Response Set-SDRS). Interviews were analyzed using interpretative phenomenological analysis (IPA). Seventeen male patients participated (PS: n = 9; OSO: n = 8). Three themes emerged from IPA: (1) PS as a somatic experience, (2) the emotional impact of PSs, and (3) searching for meaning. Quantitative analyses showed that both groups exhibited elevated trauma and anxiety levels. Effect size differences (ESD) suggested a medium ESD on depression (P = 0.176, ηp (2) = 0.118) and PTSD (avoidance: P = 0.383, ηp (2) = 0.055, numbing: P = 0.311, ηp (2) = 0.068), and a large ESD on SDRS (P = 0.081, ηp (2) = 0.189), where PS participants, comparatively, exhibited elevated levels. A medium ESD was detected on CAQ-fear (P = 0.237, ηp (2) = 0.092) where OSO participants exhibited greater heart-focused worry. The qualitative and quantitative findings of this mixed method study show convergence in terms of the emotional factors associated with the experience of PSs. PSs are often reported to be indistinguishable from objective shocks, evoking alarm, frustration, and confusion, forcing the individual to face the uncertainties of what to them is a novel and confusing experience.

Electrical storm: recent pathophysiological insights and therapeutic consequences

The implantable cardioverter-defibrillator significantly improves survival in patients with malignant ventricular arrhythmias but does not target the underlying pathological substrate responsible for arrhythmic events. A significant proportion of defibrillator recipients experience multiple ventricular tachycardia/fibrillation episodes over a short period of time, termed electrical storm (ES). The current therapeutic strategy for ES is complex and unsatisfactory because simultaneous administration of several medications and additional invasive procedures are often required to control ES. Moreover, this treatment does not favorably influence the long-term outcome. Clearly, improved ES therapies are necessary and desirable, but a lack of understanding of the pathophysiological mechanisms underlying ES has hindered the development of more effective, rationally based therapeutic approaches. This paper reviews emerging experimental and clinical findings that provide insights into the pathophysiology of ES and discusses mechanism-based innovative therapeutic strategies.

Ventricular Tachycardia Recognized as Ventricular Fibrillation by an Implantable Cardioverter Defibrillator, Due to Double Counting of the QRS Complex

A case of ventricular tachycardia misdiagnosed as ventricular fibrillation due to double counting of the tachycardia’s wide QRS complex in an implantable cardioverter defibrillator (ICD) recipient is presented. As a result, an inappropriate shock was delivered by the device instead of anti-tachycardia pacing. The reprogramming of the detection criteria in a less sensitive manner solved the problem.

Left Ventricular Scar Burden Specifies the Potential for Ventricular Arrhythmogenesis: An LGE‐CMR Study

The extent of left ventricular (LV) scar, characterized by late gadolinium enhancement cardiac MRI (LGE-CMR), has been shown to predict the occurrence of ventricular arrhythmias in implantable cardioverter defibrillator (ICD) recipients. However, the specificity of LGE-CMR for sudden cardiac death (SCD) versus non-SCD is unclear. The aim of this retrospective, observational study was to evaluate this relationship in a cohort of ICD recipients. We included consecutive patients who had undergone LGE-CMR before ICD implantation over a 4-year period (2006-2009). Scar (defined as myocardium with a signal intensity ≥50% of the maximum in scar tissue) was characterized in terms of percent scar and number of transmural LV scar segments in a 17-segment model. The endpoints were appropriate ICD therapy and all-cause mortality. Sixty-four patients (average age 66 ± 11 years, 51 male, median LVEF 30%) were included. During 42 ± 13 months follow-up, appropriate ICD therapy occurred in 28 patients (44%), and 14 patients (22%) died. Number of transmural scar segments (P = 0.005) and percentage LV scar (P = 0.03) were both significantly associated with appropriate ICD therapy. However, neither number of transmural scar segments (P = 0.32) or percent LV scar (P = 0.59) was significantly associated with all-cause mortality. In this observational study, in medium-term follow-up, the extent of LV scar characterized by LGE-CMR was strongly associated with the occurrence of spontaneous ventricular arrhythmias but not all-cause mortality. We hypothesize that scar quantification by LGE-CMR may be more specific for SCD than non-SCD, and may prove a valuable tool for the selection of patients for ICD therapy.

Abstract 13292: Comprehensive Cardiac Rehabilitation versus Treatment as Usual For Implantable Cardioverter Defibrillator Recipients Improves Exercise Capacity, General Health and Mental Health - Mixed Methods Approach Embedding Data from a Randomised Clinical Trial with Qualitative Data

Selina K Berg, 2012 Finalist and Presenting Author

The relationship between left ventricular scar and ventricular repolarization in patients with coronary artery disease: insights from late gadolinium enhancement magnetic resonance imaging

The markers of ventricular repolarization corrected QT interval (QTc), QT dispersion (QTD) and Tpeak-to-Tend interval (Tpeak-end) have shown an association with sudden cardiac death (SCD) in the general population. However, their mechanistic relationship with SCD is unclear. The study aim was to evaluate the relationship between QTc, QTD, and Tpeak-end, and the extent and distribution of left ventricular (LV) scar in patients with coronary artery disease at high SCD risk. We included 64 consecutive implantable cardioverter defibrillator (ICD) recipients (66 ± 11 years, 80% male, median left ventricular ejection fraction 30%) who had undergone late gadolinium enhancement cardiac magnetic resonance (CMR) imaging prior to device implantation over 4 years. Scar was quantified using the CMR images and characterized in terms of percent LV scar and number of LV segments with subendocardial/transmural scar. Repolarization parameters were measured on an electrocardiogram performed prior to ICD implantation. After adjustment for potential confounders there was a strong association between the number of limited subendocardial (1-25% transmurality) scar segments and QTc (P = 0.003), QTD (P = 0.002), and Tpeak-end (P = 0.008). However, there was no association between the repolarization parameters and percent LV scar or the amount of transmural scar. During a mean follow-up of 19 ± 10 months 19 (30%) patients received appropriate ICD therapy, but none of the repolarization parameters were associated with its occurrence. In this pilot study there was a strong association between limited subendocardial LV scar and prolonged QTc, QTD, and Tpeak-end. However, there was no association between any of these repolarization markers and the delivery of appropriate ICD therapy.

Standard 12-lead electrocardiography measures predictive of increased appropriate therapy in implantable cardioverter defibrillator recipients

Identification of patients most likely to benefit from implantable cardioverter defibrillator (ICD) implant remains a complex challenge. This study aimed to investigate the utility of measures derived from standard 10 s 12-lead electrocardiogrphy (ECG) without complex signal processing in predicting appropriate therapy in an ICD population. We examined 108 ICD patients for primary (n = 32) and secondary prevention (n = 76). Baseline clinical data and characteristics of QRS complex, T-wave, and heart rate from standard 12-lead ECG were examined and related to the occurrence of subsequent appropriate therapy. Over a mean follow-up of 29 ± 11 months, 44% of patients received appropriate therapy. Patients with depressed heart rate variability (HRV) (≤6.5%) were 2.68 [95% confidence interval (CI) 1.21-5.90, P = 0.015] times more likely to receive appropriate therapy than patients with HRV >6.5%. In patients with bundle branch block (BBB), large QRS dispersion of >39 ms was associated with 2.88 times risk (95% CI 1.24-6.71, P = 0.014) of experiencing appropriate therapy than those with QRS dispersion <39 ms. In patients without BBB, reduced maximum T-wave amplitude (<0.4 mV) were 3.82 times (95% CI 1.63-8.93, P = 0.002) more likely to receive appropriate therapy compared with those with maximum T-wave amplitude >0.4 mV. History of atrial arrhythmia [hazard ratio (HR) = 2.30, 95% CI 1.29-4.12, P = 0.005] and secondary prevention (HR = 2.55, 95% CI 1.14-5.71, P = 0.022) were also predictive of device therapy. Measurements from standard 12-lead ECG were predictive of appropriate therapy in a heterogeneous ICD population. Incorporation of 12-lead ECG parameters such as these into risk stratification models may improve our ability to select patients for ICD implantation.

Educational and Psychological Interventions to Improve Outcomes for Recipients of Implantable Cardioverter Defibrillators and Their Families

Significant mortality benefits have been documented in recipients of implantable cardioverter defibrillators (ICDs); however, the psychosocial distress created by the underlying arrhythmia and its potential treatments in patients and family members may be underappreciated by clinical care teams. The disentanglement of cardiac disease and device-related concerns is difficult. The majority of ICD patients and families successfully adjust to the ICD, but optimal care pathways may require additional psychosocial attention to all ICD patients and particularly those experiencing psychosocial distress. This state-of-the-science report was developed on the basis of an analysis and critique of existing science to (1) describe the psychological and quality-of-life outcomes after receipt of an ICD and describe related factors, such as patient characteristics; (2) describe the concerns and educational/informational needs of ICD patients and their family members; (3) outline the evidence that supports interventions for improving educational and psychological outcomes for ICD patients; (4) provide recommendations for clinical approaches for improving patient outcomes; and (5) identify priorities for future research in this area. The ultimate goal of this statement is to improve the precision of identification and care of psychosocial distress in ICD patients to maximize the derived benefit of the ICD.

Shock Anxiety among Implantable Cardioverter Defibrillator Recipients with Recent Tachyarrhythmia

Shock anxiety has been documented irrespective of shock exposure in implantable cardioverter defibrillator (ICD) recipients. The presence of tachyarrhythmia may lead to an anticipation of receiving a shock and thereby give rise to shock anxiety. The aims were to assess: (1) the level of shock anxiety in a sample of ICD recipients, (2) the relationship between such anxiety and shock exposure, and (3) the relationship between recent tachyarrhythmia and shock anxiety. ICD recipients (n = 167) completed the Florida Shock Anxiety Scale measure of shock anxiety. The recipients were divided into three groups: (1) Recipients with no documented tachyarrhythmia over the previous 12 months (n = 56), (2) recipients with documented tachyarrhythmia over the previous twelve months (n = 54), and (3) recipients with any history of shocks (n = 57). Of the recipients, 44% experienced some form of shock anxiety, whereas 15% reported general shock anxiety. Analyses of covariance revealed that recipients with recent tachyarrhythmia (F = 7.675 df = 9/100, P = 0.007) as well as recipients with a shock history (F = 9.976, df = 9/103, P = 0.002) reported higher levels of shock anxiety than recipients with no recent tachyarrhythmia. This study indicates that although a substantial proportion of the ICD recipients experienced some form of shock anxiety, only a relatively small proportion reported general shock anxiety. ICD recipients with recent tachyarrhythmia, in addition to recipients with shock history, appear to be at greater risk for development of shock anxiety. This implies that these recipients may profit from clinical-based strategies and interventions targeting shock anxiety.

Basal Exit Site of Clinical Ventricular Tachycardia is an Independent Predictor of Antitachycardia Pacing Failure in Implantable Cardioverter‐Defibrillators Recipients

Little is known about predictors of antitachycardia pacing (ATP) failure in implantable cardioverter defibrillator (ICD) recipients. Distance between the stimulation site and the ventricular tachycardia (VT) site of origin may critically affect ATP effectiveness. We hypothesized that ATP may be less effective in ICD patients who had basal VT than in those who had apical VT. We reviewed data from 52 patients with sustained monomorphic VT and left ventricular disease referred for ICD implantation. ATP was delivered exclusively at the right ventricular apex. The clinical VTs site of origin (basal, midventricular, or apical) was determined in each patient, using 12-lead electrocardiogram. VTs episodes treated with ATP during the 1-year follow-up were studied. ATP success rate (%), defined as the ratio between the number of successful ATP sequences and the number of delivered ATP sequences, was determined in each patient. VT exit site was apical in 19 patients (36%), basal in 18 patients (35%), and midventricular in 15 patients (29%). In those 52 patients, 1,393 ATP sequences, delivered to treat 761 VT episodes, were analyzed. ATP success rate was found to be associated with the VT site of origin (median [interquartile range]): basal (33%[11-67]), midventricular (50%[37-100]), apical (100%[41-100]) (P = 0.027). Multivariate analysis identified basal VT site of origin as an independent predictor of ATP failure (P = 0.023). ATP is less effective in ICD patients who had basal VT than in those who had apical VT before ICD implantation.

If the shoe fits: Antitachycardia pacing in children and patients with congenital heart disease

It is now more than 10 years since the publication of groundbreaking major clinic studies such as AVID and MADIT that created the foundation for clinical indications for implantable cardioverter-defibrillator (ICD) use in adults at risk for sudden death. Since that time, the technology that enables the ICD has progressed, with reductions in device size, advances in software and lead technology, and innovations in system design, making them more reliable and easier to implant. However, as increasing long-term experience with ICDs has accumulated, we have become distressingly aware that the risk reduction in cardiac sudden death-associated ICD implantation cannot be considered to be a free ride. Complications associated with long-term ICD patients are often heralded by unnecessary or frankly inappropriate shocks owing to misinterpretation of nonlethal rhythms, missensed rhythms, and lead faults. 1 van Rees J.B. Borleffs J.W. de Bie M.K. et al. Inappropriate cardioverter-defibrillator shocks. J Am Coll Cardiol. 2011; 57: 556-562 Abstract Full Text Full Text PDF PubMed Scopus (323) Google Scholar , 2 Berul C.I. Van Hare G.F. Kertesz N.J. et al. Results of a multicenter retrospective implantable cardioverter-defibrillator registry of pediatric and congenital heart patients. J Am Coll Cardiol. 2008; 51: 1685-1691 Abstract Full Text Full Text PDF PubMed Scopus (301) Google Scholar Proarrhythmic effects of inappropriate shock may rarely lead to ICD storm, and increasing data suggest that such shocks may contribute to deterioration of myocardial function and overall survival. 1 van Rees J.B. Borleffs J.W. de Bie M.K. et al. Inappropriate cardioverter-defibrillator shocks. J Am Coll Cardiol. 2011; 57: 556-562 Abstract Full Text Full Text PDF PubMed Scopus (323) Google Scholar , 3 Poole J.E. Johnson G.W. Hellkamp A.S. et al. Prognostic importance of defibrillator shocks in patients with heart failure. New Engl J Med. 2008; 359: 1009-1017 Crossref PubMed Scopus (1139) Google Scholar Perhaps equally important (although less dramatic) is the pervasive effect of both appropriate and inappropriate shocks, resulting in increased anxiety and deterioration of quality of life in both adults and children. 4 Koopman H.M. Vrijmoet-Wiersma C.M. Langius J.N. et al. Psychological functioning and disease-related quality of life in pediatric patients with an implantable cardioverter defibrillator. Pediatr Cardiol. 2012; 33: 569-575 Crossref PubMed Scopus (47) Google Scholar , 5 Jacq F. Foulldrin G. Savouré A. et al. A comparison of anxiety, depression and quality of life between device shock and nonshock groups in implantable cardioverter defibrillator recipients. Gen Hosp Psychiatry. 2009; 31: 266-273 Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar Antitachycardia pacing reduces appropriate and inappropriate shocks in children and congenital heart disease patientsHeart RhythmVol. 9Issue 11PreviewAntitachycardia pacing (ATP) can reduce implantable cardioverter-defibrillator shocks, but its use in children and patients with congenital heart disease (CHD) is not well described. Full-Text PDF

P02.35. Methodology in integrative medicine research: challenges and solutions from a randomized clinical control trial using adapted yoga

Purpose This randomized controlled clinical study evaluated the efficacy of adapted yoga (vs. usual care) to reduce psychosocial risks, which have been clinically shown to impact morbidity and mortality in implantable cardioverter defibrillator (ICD) recipients. The ICD collects and records real-time cardiac data, which were used in the study. Methods Forty-six patients participated from a hospital in Connecticut. All participants were administered validated measures on psychosocial risk factors at weeks one and eight of the eight-week intervention. Patients in the intervention group participated in a weekly adapted yoga class for eighty minutes for eight weeks with assigned home practices. Clinical measures, including patients’ current and past medical health status and device usage, were collected three months prior to the study, during the study, and at a six-month follow-up. Results Data revealed that the yoga group’s overall shock anxiety decreased while the control group’s increased, t(4.43, 36), p<0.0001 (total). The yoga group had less shock anxiety, t(2.86,36) p=0.007 (mean consequence), greater overall self-compassion, t(-2.84,37), p=0.007 (total), and greater mindfulness (equanimity) regarding emotions, t(-2.10,37) p=0.04 (mindfulness), than the control group. Exploratory analyses utilizing a linear model (R2=.98) of the observed anti-tachycardia pacing (ATP) events revealed that the expected number of ATP events in the intervention group was significantly lower than the control group. Additionally, the expected number of ATP events increased more rapidly as a function of the initial ATP events for the control group than for the intervention group. Conclusion Our study demonstrated psychological benefits from a program of adapted yoga compared to usual care for ICD recipients. Marked improvements were reported in total shock anxiety, self-compassion, sense of equanimity, and decreased likelihood of ATPs. The data supports the continuation of research in mind-body interventions to better understand the role of complementary medicine to address ICD-specific psychosocial stress and its potential contributory role in cardiac outcomes.