Patients
adjust well to device that zaps irregular heartbeats
by Christine Penko
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 ableto
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."
Recent UF Health Science Center news releases are available at www.health.ufl.edu/hscc/index.html
Thursday, May 20, 1999 University of
Florida Health Science Center and Shands HealthCare. For more
information, please call 352/392-2755 or e-mail:
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