Effects of implantable cardioverter/defibrillator shock and antitachycardia pacing on anxiety and quality of life: A MADIT-RIT substudy

• Published in: The American heart journal 2017-07, Vol.189, p.75-84
• Main Authors: Perini, Alessandro Paoletti, Kutyifa, Valentina, Veazie, Peter, Daubert, James P., Schuger, Claudio, Zareba, Wojciech, McNitt, Scott, Rosero, Spencer, Tompkins, Christine, Padeletti, Luigi, Moss, Arthur J.
• Format: Article
• Language: English
• Subjects: Anxiety; Anxiety - etiology; Anxiety - psychology; Cardiac arrhythmia; Councils; Defibrillators; Defibrillators, Implantable; Electric Countershock - instrumentation; Female; Follow-Up Studies; Heart attacks; Heart failure; Humans; Implantation; Male; Middle Aged; Mortality; Patients; Quality of Life; Questionnaires; Risk Factors; Shock; Surveys and Questionnaires; Tachycardia, Ventricular - complications; Tachycardia, Ventricular - psychology; Tachycardia, Ventricular - therapy; Therapy; Time Factors; Transplants & implants; Treatment Outcome; Women
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2017.03.009

Effects of implantable cardioverter/defibrillator (ICD) shocks and antitachycardia pacing (ATP) on anxiety and quality of life (QoL) in ICD patients are poorly understood. We evaluated changes in QoL from baseline to 9-month follow-up using the EQ-5D questionnaire in patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial—Reduce Inappropriate Therapy (MADIT-RIT) (n=1,268). We assessed anxiety levels using the Florida Shock Anxiety Scale (1-10 score) in patients with appropriate or inappropriate shocks or ATP compared to those with no ICD therapy during the first 9 months postimplant. The analysis was stratified by number of ATP or shocks (0-1 vs ≥2) and adjusted for covariates. In MADIT-RIT, 15 patients (1%) had ≥2 appropriate shocks, 38 (3%) had ≥2 appropriate ATPs. Two or more inappropriate shocks were delivered in 16 patients (1%); ≥2 inappropriate ATPs, in 70. In multivariable analysis, patients with ≥2 appropriate shocks had higher levels of shock-related anxiety than those with ≤1 appropriate shock (P .05). In MADIT-RIT, ≥2 appropriate or inappropriate ICD shocks and ≥2 appropriate ATPs are associated with more anxiety at 9-month follow-up despite no significant changes in the assessment of global QoL by the EQ-5D questionnaire. Innovative ICD programming reducing inappropriate therapies may help deal with patient concerns about the device.