CORRESPONDENCE: LETTER TO THE EDITOR
Reply
James P. Daubert, MD*,
Wojciech Zareba, MD, PhD,
Scott McNitt, MS,
Claudio Schuger, MD,
Helmut Klein, MD,
W. Jackson Hall, PhD and
Arthur J. Moss, MD
* University of Rochester Medical Center, Department of Medicine, Box 679-URMC, Rochester, New York 14642 (Email: James_Daubert{at}URMC.Rochester.edu).
We thank Dr. Pedersen and Ms. van den Broek for their interest regarding our recent article (1) and for drawing attention to the potential quality-of-life issues associated with implantable cardioverter-defibrillator (ICD) shocks. The authors emphasize that the relationship between ICD shocks, appropriate or inappropriate, and health-related quality of life is neither simple nor linear. For example, some studies have not found an effect of shocks on quality of life. Other studies either have (2) or have not (3) found an effect between number of shocks and adverse psychologic effect. Similarly, patients with multiple appropriate shocks, for example, ventricular arrhythmia storm, appear to be at particularly high risk for subsequent, largely nonsudden, death in follow-up (4). Patient-related factors such as age or personality type likely do play a role in the magnitude of effect a shock has on the patient (1,5,6). In MADIT II (Multicenter Automatic Defibrillator Trial II), while personality subtypes, such as type D (7), were not specifically inventoried or analyzed (8), mental health was not observed to change in patients completing follow-up quality-of-life questionnaires, although declines in physical health were noted for patients experiencing appropriate shocks, likely due to worsening congestive heart failure (9). In summary, further work is needed to reduce the occurrence of ICD shocks, both appropriate and inappropriate, while maintaining the mortality reduction with ICDs, and to anticipate, understand, and mitigate the effects of the shocks when they cannot be prevented.
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References
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1. Daubert JP, Zareba W, Cannorm, et al. MADIT II Investigators Inappropriate implantable cardioverter-defibrillator shocks in the MADIT II study: frequency, mechanisms, predictors, and survival impact J Am Coll Cardiol 2008;51:1357-1365.[Abstract/Free Full Text]2. Irvine J, Dorian P, Baker B, et al. Quality of life in the Canadian Implantable Defibrillator Study (CIDS) Am Heart J 2002;144:282-289.[Web of Science][Medline] 3. Schron EB, Exner DV, Yao Q, et al. Quality of life in the antiarrhythmics versus implantable defibrillators trial: impact of therapy and influence of adverse symptoms and defibrillator shocks Circulation 2002;105:589-594.[Abstract/Free Full Text] 4. Sesselberg HW, Moss AJ, McNitt S, et al. Ventricular arrhythmia storms in postinfarction patients with implantable defibrillators for primary prevention indications: a MADIT-II substudy Heart Rhythm 2007;4:1395-1402.[CrossRef][Web of Science][Medline] 5. Sears Jr. SF, Shea JB, Conti JB. Cardiology patient page. How to respond to an implantable cardioverter-defibrillator shock. Circulation 2005;111:e380-e382.[Free Full Text] 6. Engel GL. From biomedical to biopsychosocial. Being scientific in the human domain. Psychosomatics 1997;38:521-528.[Abstract/Free Full Text] 7. Pedersen SS, Theuns DAMJ, Muskens-Heemskerk A, Erdman RAM, Jordaens L. Type-D personality but not implantable cardioverter-defibrillator indication is associated with impaired health-related quality of life 3 months post-implantation Europace 2007;9:675-680.[Abstract/Free Full Text] 8. Noyes K, Corona E, Zwanziger J, et al. Health-related quality of life consequences of implantable cardioverter defibrillators: results from MADIT II Med Care 2007;45:377-385.[CrossRef][Web of Science][Medline] 9. Piotrowicz K, Noyes K, Lyness JM, et al. Physical functioning and mental well-being in association with health outcome in patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial II Eur Heart J 2007;28:601-607.[Abstract/Free Full Text]
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Implantable Cardioverter-Defibrillator Shocks and Their Adverse Impact on Patient-Centered Outcomes: Fact or Fiction?
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