Wójcicka Mariola, Lewandowski Michał, Smolis-Bak Edyta, Szwed Hanna
Institute of Cardiology, 2nd Coronary Artery Disease Department, Warsaw, tel, Poland.
Kardiol Pol. 2008 Oct;66(10):1050-8; discussion 1059-60.
Implantable cardioverter-defibrillators (ICD) are the most effective treatment in patients with the risk of sudden cardiac death. ICD improves patients' safety but is also the source of numerous inconveniences. Especially young people consider such ICD-related inconveniences as most unwelcome.
To assess the quality of life and main psychological problems encountered in young adults with an ICD.
We studied 45 subjects aged 14-29 years (mean 21.2+/-4.3). ICDs were used in primary prevention in 22 patients, and in secondary prevention in 23 patients. Time elapsed from implantation ranged from 5 months to 11 years (4.3+/-2.7 years). Since the problems affecting this group were rather specific, the patients' quality of life was assessed with a special questionnaire addressing important issues and problems associated with living with an ICD.
ICD discharges were observed in 67.4% of patients (primary prevention - 45.5%, secondary prevention - 82.6%), multiple shocks in 47.2%, and phantom shocks in 21.4%. Anxiety associated with an ICD discharge was reported by 84.4% of patients. In order to prevent ICD discharges, 53.3% of patients decreased their activity. Problems with memory were observed in 42.2% of patients, with concentration in 47.6%, and with sleep in 42.2%. Almost half of those over 18 years of age were active drivers. None of the subjects experienced an ICD discharge during sexual intercourse. None of the men reported any sexual problems, while seven (41.2%) women did. Almost a quarter of the patients claimed to have had complications after the implantation. Young adult patients generally were compliant to have their ICD checked and accepted their limitations and disease. Fewer people assessed their health status as bad. Some patients in the group studied found it extremely difficult to accept their disease and/or ICD and to adapt to the situation. As many as nine patients believed the ICD implantation had been unnecessary, seven did not accept the ICD, three patients thought negatively of follow-up visits, three were not compliant, 13 did not accept the limitations, four refused to accept the fact that their disease existed, and seven refused to do anything. At least four patients talked or thought about having the ICD removed.
Patients with ICD have problems in different spheres of their activity (physical, psychological, and social). Such patients need to be informed appropriately about the ICD itself and its functioning. They should be granted psychological support from health professionals who are familiar with the specific problems of ICD recipients.
植入式心脏复律除颤器（ICD）是预防心脏性猝死最有效的治疗手段。ICD提高了患者的安全性，但也带来了诸多不便。尤其是年轻人认为这些与ICD相关的不便非常令人讨厌。
评估植入ICD的年轻人的生活质量及主要心理问题。
我们研究了45名年龄在14至29岁（平均21.2±4.3岁）的受试者。22例患者的ICD用于一级预防，23例患者用于二级预防。植入后的时间间隔为5个月至11年（4.3±2.7年）。由于影响该群体的问题较为特殊，因此使用一份专门的问卷评估患者的生活质量，该问卷涉及与ICD共存相关的重要问题。
67.4%的患者发生过ICD放电（一级预防患者中占45.5%，二级预防患者中占82.6%），47.2%的患者经历过多次电击，21.4%的患者有过假性电击。84.4%的患者报告有与ICD放电相关的焦虑。为了预防ICD放电，53.3%的患者减少了活动量。42.
