Assessment of Anxiety Level in Patients Receiving Implantable Cardioverter Defibrillator

Introduction More than 80% of cardiac arrest cases are initiated by a sudden onset of ventricular tachycardia which swiftly makes progress toward ventricular fibrillation. Since the spontaneous cessation of ventricular fibrillation is a rare phenomenon, it should be treated as soon as it occurred. The best treatment methods for this group of patients involve cardiopulmonary resuscitation and defibrillation. The time gap between the onset of a heart attack and the initiation of attempts to defibrillate the cardiac muscle is regarded as an important determining factor for patient’s survival. Therefore, the mortality rate in the patients who suffer from cardiac arrest outside of the hospital is too high because patients are unable to receive emergency medical care and this delay may cause sudden cardiac death (1). Implantable cardioverter-defibrillator (ICD) is a valuable device that was invented for saving patients who confront life-threatening dysrhythmia related to ventricles by preventing them from sudden cardiac death. ICD is a device that doctors use for monitoring patients who suffer from life-threatening dysrhythmia (2). If there is a ventricular dysrhythmia, ICD delivers electrical impulses to the cardiac muscle in order to regulate the heart rhythm. The delivered energy can be customized according to the individual patient’s need. ICD delivers a variable range of electrical energy to the cardiac muscle within 10 to 20 seconds of dysrhythmia onset. This period of time is considered as the valuable time for treating fatal ventricular dysrhythmia. ICD is implanted in the left pectoral region by a method which is the same as implantation of a permanent pacemaker (Table 1). The device is implanted in a patient either as single chambered or dual chambered (3). ICD was implanted for the first time in a human body by Mirowski and his colleagues in John Hopkins Hospital in 1980 (3). The Food and Drug Administration (FDA) approved using ICD for the treatment of patients who suffer from ventricular dysrhythmias in 1985. Thereafter, it has been generally used in a wide range and was implanted globally in over 50 000 cases (3). In 2009, a published report showed that there are approximately 100 000 patients who have been cured by ICD and there Abstract Objectives: The implantable cardioverter-defibrillator (ICD) is a device that is used for patients who suffer from dangerous ventricular dysrhythmia like ventricular tachycardia or ventricular fibrillation by preventing them from sudden cardiac death. Our knowledge about psychological reactions and adaptability after insertion of ICD is not enough, so we did this study to assess and compare anxiety level in patients before and after ICD implantation. Materials and Methods: In this comparative cross-sectional study, after providing written informed consent, 95 eligible patients (30 females and 65 males) were selected through convenience sampling in Shahid Rajaee heart hospital and the medical centers related to Tehran Arrhythmia Clinic. A demographic questionnaire and HADS (Hospital Anxiety and Depression Scale) questionnaire were used to measure anxiety level before and 4 weeks after implantation of ICD. In this study, data were collected and analyzed using SPSS software version 14.0. Results: The mean ± SD of anxiety was significantly lower in male patients than in females prior to inserting ICD device (M = 7.55±4.95 vs. F = 10.93±5.34, P = 0.003) and also after insertion (M = 7.76±5.76 vs. F = 12.06±6.68, P = 0.001). Conclusions: We found that women had a higher level of anxiety before and after ICD implantation. Since sex is a predisposing factor for encountering a higher level of anxiety, health care providers need to notice the role of gender when providing psychological support for patients with ICD.