Journal Article

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

Padeletti, Luigi, Perini, Alessandro Paoletti, Zareba, Wojciech, Rosero, Spencer, Moss, Arthur J., Veazie, Peter, McNitt, Scott, Kutyifa, Valentina, Daubert, James P., Tompkins, Christine, Schuger, Claudio

2017

Overview

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<.01). Furthermore, ≥2 inappropriate shocks produced more anxiety than ≤1 inappropriate shock (P=.005). Consistently, ≥2 appropriate ATPs resulted in more anxiety than ≤1 (P=.028), whereas the number of inappropriate ATPs showed no association with anxiety levels (P=.997). However, there was no association between QoL and appropriate or inappropriate ATP/shock (all P values > .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.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Anxiety / Anxiety - etiology / Anxiety - psychology / Cardiac arrhythmia / Cardiovascular / 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