Cevik Cihan, Perez-Verdia Alejandro, Nugent Kenneth
Department of Internal Medicine, Texas Tech University Health Sciences Center, 3601 4th Street, Lubbock, TX 79430, USA.
Europace. 2009 Jun;11(6):710-5. doi: 10.1093/europace/eup091. Epub 2009 Apr 8.
Patients with an implantable cardioverter defibrillator (ICD) implanted for primary prevention have an increased mortality rate if they receive appropriate and/or inappropriate ICD shocks. The most common cause of increased mortality is worsening heart failure. ICD shocks cause direct myocardial injury, contraction band necrosis, and fibrosis, and could induce persistent inflammation. These changes likely contribute to the ventricular dysfunction in patients who have a significantly depressed ejection fraction initially. One-third of the patients with ICDs have psychiatric disorders. Studies have demonstrated that the patients have decreased quality of life, including emotional dysfunction, during the month following an ICD shock. Patients with anxiety and depression have an activated hypothalamus-hypophysis-adrenal axis, increased sympathetic activity, and decreased vagal tone. Chronic sympathetic stimulation could directly affect the myocardium and worsen cardiac dysfunction. Consequently, although ICD implantation is life-saving, it may contribute to heart failure progression. Completed trials need reanalysis to determine whether there are unique characteristics of patients receiving shocks that might lead to additional therapy. Furthermore, the interaction between psychiatric disorders and ICD therapy needs more study.
因一级预防而植入植入式心脏复律除颤器（ICD）的患者，若接受了适当和/或不适当的ICD电击，其死亡率会升高。死亡率增加的最常见原因是心力衰竭恶化。ICD电击会导致直接心肌损伤、收缩带坏死和纤维化，并可能引发持续性炎症。这些变化可能导致最初射血分数显著降低的患者出现心室功能障碍。三分之一的ICD患者患有精神疾病。研究表明，在ICD电击后的一个月内，患者的生活质量下降，包括情绪功能障碍。焦虑和抑郁患者的下丘脑 - 垂体 - 肾上腺轴激活，交感神经活动增加，迷走神经张力降低。慢性交感神经刺激可直接影响心肌并使心脏功能障碍恶化。因此，尽管ICD植入能挽救生命，但它可能会促使心力衰竭进展。已完成的试验需要重新分析，以确定接受电击的患者是否有独特特征，可能需要额外治疗。此外，精神疾病与ICD治疗之间的相互作用需要更多研究。
