Varghese Swaroop, Geller J Christoph, Ohlow Marc-Alexander
Division of Internal Medicine I, Klinikum Wernigerode, Wernigerode, Germany.
Division of Invasive and Interventional Electrophysiology, Zentralklinik, Bad Berka, Germany.
Herzschrittmacherther Elektrophysiol. 2019 Sep;30(3):306-312. doi: 10.1007/s00399-019-00645-y. Epub 2019 Aug 22.
Implantable cardioverter defibrillators (ICDs) are designed to deliver shocks in the event of ventricular arrhythmias. Some ICD recipients experience the sensation of ICD discharge in the absence of an actual discharge (phantom shock, PS).
The aim of this study was to evaluate the incidence, predictors, and consequences of PS in ICD recipients.
Consecutive ICD recipients were examined during a routine outpatient follow-up (FU) visit. Subjects completed a written survey; their level of depression and anxiety was assessed with the hospital anxiety and depression scale (HADS). Quality of life (QOL) was assessed using the Minnesota living with heart failure questionnaire.
Of 434 patients invited to the study, 423 (97.5%) ICD recipients agreed to and completed the survey; 349 (83%) had a primary prevention indication and 339 (80%) ischemic cardiomyopathy. A total of 27 patients (6.4%) reported a PS during a mean FU of 64 ± 44 months (5.4% in the primary prevention group and 10.8% in the secondary prevention group; p = 0.11). PS were related to higher education (≥bachelor's degree 41% versus 20%; p = 0.03), and more frequent in patients receiving adequate shocks during FU (34% versus 0.5%; p < 0.001). HADS score levels were higher following PS (15 ± 6 versus 8.8 ± 7.4; p < 0.001). The majority of patients reporting PS felt that the information provided to them prior to ICD placement was insufficient (22.2% versus 5.0%), that they needed psychological support after ICD implantation (26% versus 3%), and considered ICD deactivation in near end-of-life situations (59% versus 29%; p < 0.001 for all).
PS occur in 6.4% of all ICD recipients and are related to higher education and to patients that experienced adequate shocks during FU.
植入式心脏复律除颤器（ICD）旨在在发生室性心律失常时进行电击。一些ICD接受者在没有实际电击的情况下会感觉到ICD放电（假性电击，PS）。
本研究的目的是评估ICD接受者中PS的发生率、预测因素和后果。
在常规门诊随访（FU）期间对连续的ICD接受者进行检查。受试者完成一份书面调查问卷；使用医院焦虑抑郁量表（HADS）评估他们的抑郁和焦虑水平。使用明尼苏达心力衰竭生活问卷评估生活质量（QOL）。
在受邀参加研究的434例患者中，423例（97.5%）ICD接受者同意并完成了调查；349例（83%）有一级预防指征，339例（80%）有缺血性心肌病。在平均64±44个月的随访期间，共有27例患者（6.4%）报告有PS（一级预防组为5.4%，二级预防组为10.8%；p = 0.11）。PS与高等教育相关（≥学士学位者为41%，而其他为20%；p = 0.03），并且在随访期间接受过足够电击的患者中更常见（34%对0.5%；p < 0.001）。PS后HADS评分水平更高（15±6对8.8±7.4；p < 0.001）。大多数报告有PS的患者认为在植入ICD之前提供给他们的信息不足（22.2%对5.0%），他们在植入ICD后需要心理支持（26%对3%），并考虑在接近生命末期的情况下停用ICD（59%对29%；所有p值均< 0.001）。
PS发生在6.4%的ICD接受者中，并且与高等教育以及在随访期间经历过足够电击的患者有关。
