Burke J L, Hallas C N, Clark-Carter D, White D, Connelly D
Centre for Health Psychology, School of Sciences, Staffordshire University, Stoke on Trent, UK.
Br J Health Psychol. 2003 May;8(Pt 2):165-78. doi: 10.1348/135910703321649141.
The implantable cardioverter defibrillator (ICD) has become the treatment of choice for ventricular arrhythmia (VA; abnormal heart rhythms) and the prevention of sudden cardiac death (SCD). Recent clinical trials have shown the ICD to be superior to anti-arrhythmic medication in reducing mortality; however, research has suggested that ICD recipients experience poor psychosocial adjustment following implantation of the device. This aim of this study was to identify the key psychological characteristics associated with ICD implantation and to establish whether poor psychosocial outcome can be attributed directly to the device and its therapy.
Studies which reported valid and reliable measures of psychological functioning in ICD patients and appropriate comparison groups were considered for inclusion in a meta-analytic review. A systematic search of electronic databases and reference lists identified 20 studies which fulfilled the inclusion criteria.
There were no significant differences in psychosocial outcome between ICD patients and drug-maintained VA patients or between pre- and post-implant ICD patients. However, ICD patients reported significantly worse psychological functioning and physical functioning than other cardiac controls.
These findings suggest that poor psychosocial outcome in ICD patients may occur as a result of variables associated with the underlying VA condition, rather than as a direct response to implantation of the device and its therapy. This holds important implications for the development and implementation of psychological interventions for patients experiencing VA, in preference to ICD-specific programmes.
植入式心脏复律除颤器（ICD）已成为治疗室性心律失常（VA；异常心律）和预防心源性猝死（SCD）的首选治疗方法。近期临床试验表明，在降低死亡率方面，ICD优于抗心律失常药物；然而，研究表明，ICD植入患者在植入该设备后心理社会适应不良。本研究的目的是确定与ICD植入相关的关键心理特征，并确定心理社会不良结果是否可直接归因于该设备及其治疗。
纳入报告了ICD患者心理功能有效可靠测量方法及适当对照组的研究，进行荟萃分析。通过对电子数据库和参考文献列表的系统检索，确定了20项符合纳入标准的研究。
ICD患者与药物维持治疗的VA患者之间，以及ICD植入前后的患者之间，心理社会结果无显著差异。然而，ICD患者报告的心理功能和身体功能明显比其他心脏疾病对照组差。
这些发现表明，ICD患者心理社会不良结果可能是由与潜在VA疾病相关的变量导致的，而不是对设备植入及其治疗的直接反应。这对于为VA患者制定和实施心理干预措施具有重要意义，而不是优先制定针对ICD的特定方案。
