Psychosocial aspects of cardiac pacing

The psychosocial effects of pacemaker implantation were analysed in 96 randomly selected patients receiving their first pacemaker at the Johannesburg General Hospital from August 1976 to December 1977. Premorbid personality together with emotional acceptance of the pacemaker was assessed by a social worker at interviews before implantation and 3 months and 1 year after implantation. Depression was measured by the Hamilton rating scale, and a psychosocial history was taken from each patient. The nature and severity of symptoms and associated diseases were assessed medically. Pacemaker implantation restores most patients to occupational, social, emotional and physical usefulness. The degree of relief of symptoms played an important part in rehabilitation. Inadequate adjustment and rehabilitation may occur in the presence of additional disease, unrealistic patient expectations, an inadequate, depressive personality type, poor doctor-patient communication, or in patients who have experienced symptoms for less than 1 month before the implantation. Adequate pre-operative preparation by a team of social workers and doctors together with public education and the provision of postoperative psychosocial support for the inadequate, depressive personality type and for patients suffering from additional disease is likely to enhance rehabilitation greatly.