Related Experiment Video
Updated: Jun 6, 2026
Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs
Published on: April 17, 2021
Psychopathology in postinfarction patients implanted with cardioverter-defibrillators for secondary prevention. A
Anthony P Redhead1, Douglas Turkington, Sanjay Rao
1Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK.
Insights
High rates of anxiety and depression affect patients with implantable cardioverter-defibrillators (ICDs) and their spouses. Experiencing ICD shocks, especially shock storms, significantly increases anxiety in patients and contributes to spouse anxiety.
Area of Science:
- Cardiology
- Psychiatry
- Psychosocial Health
Background:
- Patients receiving implantable cardioverter-defibrillators (ICDs) for secondary arrhythmia protection post-myocardial infarction may experience significant psychological distress.
- Comorbidities and therapeutic interventions like shock therapy can impact psychosocial adjustment in these patients.
Purpose of the Study:
- To assess the incidence of anxiety and depression in patients with ICDs after myocardial infarction.
- To investigate the influence of comorbidity and shock therapy on psychosocial maladjustment in ICD recipients.
- To evaluate anxiety levels in spouses of ICD recipients.
Main Methods:
- A cross-sectional, questionnaire-based study involving ICD recipients (n=100) and matched control groups (pacemaker, coronary intervention, atrial fibrillation).
- Psychosocial well-being assessed using the Hospital Anxiety and Depression Scale (HADS) and MOS SF-36.
- Spouses of participants (n=106) were also included in the study.
Main Results:
- While mean scores were similar across groups, individual assessments revealed high incidences of anxiety (24-34%) and depression (14-22%) in all patient groups.
- Implantable cardioverter-defibrillator (ICD) shocks, particularly 'shock storms,' significantly heightened anxiety, with 63.6% of shock-storm recipients meeting anxiety 'caseness' criteria.
- High anxiety rates were also observed in spouse groups (25-48%).
Conclusions:
- Experiencing 'shock storms' from ICDs precipitates pathological anxiety levels in patients.
- The need for an ICD contributes to anxiety in spouses, highlighting the importance of psycho-education for them.
- Individual cognitive behavioral therapy (CBT) and potential anxiolytic/antidepressant medications are recommended for patients experiencing multiple shocks and their families.
Objective:
To determine (1) the incidence of anxiety and depression in patients implanted with defibrillators for secondary arrhythmia protection after myocardial infarction; (2) the effect of comorbidity and receipt of shock therapy on psychosocial maladjustment.
Methods:
Cross-sectional, one-off, questionnaire-based (HADS; MOS SF-36), case-controlled study of defibrillator recipients (n=100) from a 3-year implant period and three groups of matched controls [pacemaker (n=50), coronary intervention (n=50), atrial fibrillation (n=50)], sharing specific preselected previous health experiences. Spouses of each subgroup (n=106) were also studied. Although a cardiac rehabilitation program was available routinely for postinfarction patients, no specific rehabilitation was provided after defibrillator or pacemaker implant.
Results:
Mean scores for each assessment were similar for each group. Individual patient scores, however, revealed similarly high incidences of anxiety (24-34%) and depression (14-22%) in all groups. Experience of implantable cardioverter-defibrillator (ICD) 'shock(s)' and 'shock storm(s)' (≥ 3 shocks in 24 h) increased anxiety significantly. HADS criteria for anxiety 'caseness' or borderline 'caseness' were met in 63.6% of shock-storm recipients. Abnormal anxiety scores did not differ with interval from index event. Individual HADS scores also identified high incidences of anxiety in all spouse groups (25-48%).
Conclusions:
Experience of shock storm precipitates pathological levels of anxiety in ICD recipients, and need for an ICD contributes to spouse anxiety. Individual CBT is indicated for patients who experience multiple shocks along with psycho-education for spouses. Anxiolytic and antidepressant medications may be indicated as part of their psychological rehabilitation.
Related Concept Videos
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:29Cardiomyopathy V: Interprofessional Care
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:26Coronary Artery Disease II: Pathophysiology
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations