Plakoutsi Sofia, Florou Elizabeth, Sfairopoulos Dimitrios, Skapinakis Petros, Korantzopoulos Panagiotis
First Department of Cardiology, University of Ioannina Medical School, Ioannina, Greece.
Department of Psychiatry, University of Ioannina School of Medicine, University of Ioannina, Ioannina, Greece.
J Geriatr Cardiol. 2025 Feb 28;22(2):255-264. doi: 10.26599/1671-5411.2025.02.003.
Implantable cardioverter defibrillators (ICDs) represent an established therapeutic strategy for the prevention of sudden cardiac death and reduction of mortality in high-risk patients, while ICDs with cardiac resynchronization therapy defibrillators improve morbidity, quality of life, and mortality in eligible patients with heart failure who are on optimal medical therapy. However, these devices may adversely affect the patients' psychological status after the delivery of shock therapies or even because of the fear of impending therapy. On the other hand, the potential of effective treatment of malignant arrhythmias may provide a 'safety' sensation in most treated patients without significant impairment in the quality of life during periods of clinical stability. During the past few years, an increasing number of reports have investigated psychological distress, including depression and anxiety status in ICD/cardiac resynchronization therapy defibrillator recipients. However, heterogeneous results have been reported while data on the variation of these psychological indexes over time in implanted patients are quite limited. Several intrinsic and extrinsic factors affect the psychological status of these patients while variations of these disturbances in specific populations are evident. Factors that seem to be associated with a greater risk for depression and anxiety in this setting include female gender, younger age, and device shock therapies. Moreover, depression and anxiety may have an adverse impact on patients' clinical outcomes exacerbating heart failure and increasing the arrhythmic risk. In this brief review article, we provide a concise and critical overview of the current literature on this topic, and we also discuss unresolved and conflicting issues delineating future perspectives.
植入式心脏复律除颤器（ICD）是预防心脏性猝死和降低高危患者死亡率的既定治疗策略，而具备心脏再同步治疗功能的ICD可改善接受最佳药物治疗的符合条件的心力衰竭患者的发病率、生活质量并降低死亡率。然而，这些装置在进行电击治疗后甚至由于对即将到来的治疗的恐惧，可能会对患者的心理状态产生不利影响。另一方面，有效治疗恶性心律失常的潜力可能会在大多数接受治疗的患者中产生一种“安全”感，且在临床稳定期对生活质量无明显损害。在过去几年中，越来越多的报告调查了ICD/具备心脏再同步治疗功能的除颤器接受者的心理困扰，包括抑郁和焦虑状态。然而，报告结果存在异质性，而关于植入患者这些心理指标随时间变化的数据相当有限。几个内在和外在因素会影响这些患者的心理状态，同时在特定人群中这些干扰的变化很明显。在这种情况下，似乎与抑郁和焦虑风险较高相关的因素包括女性、较年轻的年龄以及装置电击治疗。此外，抑郁和焦虑可能会对患者的临床结局产生不利影响，加剧心力衰竭并增加心律失常风险。在这篇简短的综述文章中，我们对关于该主题的当前文献进行了简明扼要且批判性的概述，并且我们还讨论了未解决和相互矛盾的问题，勾勒了未来的前景。
