Varghese Swaroop, Geller J Christoph, Ohlow Marc-Alexander
Division of Cardiology, Ameosklinikum Halberstadt, Halberstadt, Germany.
Division of Invasive and Interventional Electrophysiology, Zentralklinik, Bad Berka, Germany.
Herzschrittmacherther Elektrophysiol. 2020 Mar;31(1):77-83. doi: 10.1007/s00399-020-00675-x. Epub 2020 Feb 20.
Implantable cardioverter-defibrillators (ICDs) are designed to deliver therapy in the event of malignant ventricular arrhythmias. Despite their benefits, some ICD recipients regret their decision on device implantation.
The aim of this study was to evaluate the incidence, predictors, and consequences of recipients that regretted their decision after implantation.
A questionnaire-based cross-sectional survey of consecutive ICD recipients examined during a routine outpatient follow-up visit was conducted. 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 ICD recipients invited to the study, 423 (97.5%) agreed and completed the survey, 349 (83%) had a primary prevention indication, and 339 (80%) ischemic cardiomyopathy. A total of 41 recipients (9.7%) regretted their decision to undergo ICD implantation. These patients were: (1) younger (63 versus 69 years), (2) more frequently in New York Heart Association (NYHA) ≥2 functional class (63% versus 22%), (3) had higher education levels (more than high-school: 76% versus 60%), (4) felt that preoperative information was lacking (22% versus 4%), (5) had more complications in the perioperative period (15% versus 3%), (6) felt less safe after ICD implantation (54% versus 5%), and (7) considered more frequently ICD deactivation during near end-of-life situations (54% versus 29%). Mean QOL and HADS scores were significantly worse in these patients (36 versus 30 and 12 versus 8.8 points, respectively; p < 0.01 for all).
Almost 10% of ICD recipients regretted their decision after implantation. Predictors included younger age, higher education levels, complicated perioperative period, and lack of preoperative information.
植入式心脏复律除颤器（ICD）旨在在发生恶性室性心律失常时提供治疗。尽管其有诸多益处，但一些ICD植入者对植入设备的决定感到后悔。
本研究的目的是评估植入后后悔其决定的接受者的发生率、预测因素及后果。
对在常规门诊随访期间检查的连续ICD接受者进行基于问卷的横断面调查。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名ICD接受者中，423名（97.5%）同意并完成了调查，349名（83%）有一级预防指征，339名（80%）患有缺血性心肌病。共有41名接受者（9.7%）后悔其接受ICD植入的决定。这些患者：（1）年龄较轻（63岁对69岁），（2）纽约心脏协会（NYHA）≥2级功能分级的比例更高（63%对22%），（3）教育水平更高（高中以上：76%对60%），（4）觉得术前信息不足（22%对4%），（5）围手术期并发症更多（15%对3%），（6）ICD植入后感觉安全性更低（54%对5%），（7）在接近生命末期时更频繁地考虑停用ICD（54%对29%）。这些患者的平均QOL和HADS评分明显更差（分别为36分对30分和12分对8.8分；所有p<0.01）。
近10%的ICD接受者在植入后后悔其决定。预测因素包括年龄较小、教育水平较高、围手术期复杂以及术前信息不足。
