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Folie à deux: an old diagnosis with a new technology
Patrick Cervini1, David Newman, Paul Dorian
1Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Insights
Psychiatric complications can necessitate the removal of implantable cardioverter defibrillators (ICDs). This case highlights a patient
Area of Science:
- Cardiology
- Psychiatry
- Medical Ethics
Background:
- Implantable cardioverter defibrillators (ICDs) are crucial for managing life-threatening ventricular tachyarrhythmias.
- While ICD explantation is sometimes indicated, psychiatric reasons have not been primary drivers for removal.
Observation:
- A patient requested ICD explantation due to a belief that its titanium components absorbed harmful electromagnetic energy.
- This belief caused significant psychosocial distress for the patient and her husband, manifesting as fatigue, diaphoresis, and anxiety.
Findings:
- This case represents the first reported instance of a psychiatric complication serving as the primary indication for ICD explantation.
- The patient's delusion regarding electromagnetic energy absorption led to a request for device removal.
Implications:
- This case underscores the complex interplay between medical devices, patient beliefs, and mental health.
- It highlights diagnostic challenges, patient competency assessments, and the critical importance of quality of life in clinical decision-making regarding ICDs.
Abstract:
The implantable cardioverter defibrillator (ICD) is the treatment of choice for life-threatening ventricular tachyarrhythmias. Despite this, indications for explantation have been described. Psychiatric complications have been considered in the decision to not re-implant a previously explanted device but never as a primary indication for explantation. The case of a woman who requested ICD explantation amidst concerns that the titanium used in its construction was absorbing harmful negative electromagnetic field energy from the environment resulting in intermittent bouts of fatigue, diaphoresis and an overall sense of impending doom is presented. She and her husband had significant psychosocial impairment because of this belief system. The present case is the first known report of a psychiatric complication as the primary indication for ICD explantation. It is illustrative of diagnostic dilemmas, competency and the importance of quality of life.