Zusammenfassung
Mehrfachschocks stellen für viele der Betroffenen eine massive außeralltägliche Belastung dar. Trotzdem werden die psychischen Auswirkungen sowie Erfolg versprechende psychotherapeutische Behandlungstechniken erst in den letzten Jahren wissenschaftlich untersucht. Derzeit ist bekannt, dass mehrere Schockabgaben in einem kleinen Zeitfenster zu vermehrten psychischen Problemen führen, unter anderem zu Depressionen, Angststörungen oder posttraumatischen Belastungsstörungen. Insbesondere die Applikation von 5 oder mehr ICD-Schocks ist mit einer verschlechterten Lebensqualität und psychischen Beeinträchtigungen verbunden. Für Betroffene gibt es allerdings nur ungenügend Hilfsangebote. Dies liegt zum einen an der uneinheitlichen Klassifizierung psychischer Folgeerscheinungen als auch an der geringen Forschung auf diesem Gebiet. Aufklärung von Betroffenen sowie entsprechende Hilfsangebote sollten vom Kardiologen in die Patientenbetreuung integriert werden, um die psychischen Folgeerscheinungen von Mehrfachschocks zu reduzieren bzw. ihnen vorzubeugen.
Abstract
Research on the psychological influence of electrical storms is rare compared to the number of patients suffering from these major events. It is known that multiple shocks within a short period of time can lead to depression, anxiety or post-traumatic stress disorder, influencing the everyday life of patients. Especially patients experiencing five or more shocks report a significant reduction in quality of life as well as associated symptoms of psychological impairment. However, only a few therapeutic programmes exist. Inconsistencies in classification of psychological symptoms might be responsible for this lack of research. To improve clinical and out-of-hospital care cardiologists should provide psychoeducation and collaborate with psychologists specialized in addressing the needs of these patients.
Literatur
Stutts LA, Cross NJ, Conti JB, Sears SF (2007) Examination of research trends on patient factors in patients with implantable cardioverter defibrillators. Clin Cardiol 30:64–68
Camm AJ, Sears SF, Todaro JF et al (1999) Examining the psychosocial impact of implantable cardioverter defibrillators: a literature review. Clin Cardiol 22:481–489
Francis J, Johnson B, Niehaus M (2006) Quality of life in patients with implantable cardioverter defibrillators. Indian Pacing Electrophysiol J 6:173–181
Shedd OL, Sears SF, Harvill JL et al (2004) The World Trade Center attack: increased frequency of defibrillator shocks for ventricular arrhythmias in patients living remotely from New York City. J Am Coll Cardiol 44:1265–1267
Duru F, Buchi S, Klaghofer R et al (2001) How different from pacemaker patients are recipients of implantable cardioverter-defibrillators with respect to psychosocial adaptation, affective disorders, and quality of life? Heart 85:375–379
Pedersen SS, Sears SF, Burg MM, Broek KC van den (2009) Does ICD indication affect quality of life and levels of distress? Pacing Clin Electrophysiol 32:153–156
Kohn CS, Petrucci RJ, Baessler C et al (2000) The effect of psychological intervention on patients‘ long-term adjustment to the ICD: a prospective study. Pacing Clin Electrophysiol 23:450–456
Sears SF Jr, Rauch S, Handberg E, Conti JB (2001) Fear of exertion following ICD storm: considering ICD shock and learning history. J Cardiopulm Rehabil 21:47–49
Sears SF, Sowell LD, Kuhl EA et al (2007) The ICD shock and stress management program: a randomized trial of psychosocial treatment to optimize quality of life in ICD patients. Pacing Clin Electrophysiol 30:858–864
Sears SE Jr, Conti JB (2003) Understanding implantable cardioverter defibrillator shocks and storms: medical and psychosocial considerations for research and clinical care. Clin Cardiol 26:107–111
Sears SF Jr, Todaro JF, Lewis TS et al (1999) Examining the psychosocial impact of implantable cardioverter defibrillators: a literature review. Clin Cardiol 22:481–489
Bardy GH (2005) Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 352:2146
The Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators (1997) A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. N Engl J Med 337:1576–1583
Credner SC, Klingenheben T, Mauss O et al (1998) Electrical storm in patients with transvenous implantable cardioverter-defibrillators – incidence, management and prognostic implications. J Am Coll Cardiol 32:1909–1915
Exner DV, Pinski SL, Wyse DG et al (2001) Electrical storm presages nonsudden death – the Antiarrhythmics versus Implantable Defibrillators (AVID) trial. Circulation 103:2066–2071
Bansch D, Bocker D, Brunn J et al (2000) Clusters of ventricular tachycardias signify impaired survival in patients with idiopathic dilated cardiomyopathy and implantable cardioverter defibrillators. J Am Coll Cardiol 36:566–573
Perez-Villacastin J, Carmona S Jr, Hernandez MA et al (1999) The clinical practice guidelines of the Sociedad Espanola de Cardiologia on the automatic implantable defibrillator. Rev Esp Cardiol 52:1083–1104
Sesselberg HW, Moss AJ, McNitt S et al (2007) Ventricular arrhythmia storms in postinfarction patients with implantable defibrillators for primary prevention indications: a MADIT-II substudy. Heart Rhythm 4:1395–1402
Hohnloser SH, Al-Khalidi HR, Pratt CM et al (2006) Electrical storm in patients with an implantable defibrillator: incidence, features, and preventive therapy: insights from a randomized trial. Eur Heart J 27:3027–3032
Greene M, Newman D, Geist M et al (2000) Is electrical storm in ICD patients the sign of a dying heart? Outcome of patients with clusters of ventricular tachyarrhythmias. Europace 2:263–269
Pedersen SS, Theuns DA, Jordaens L, Kupper N (2010) Course of anxiety and device-related concerns in implantable cardioverter defibrillator patients the first year post implantation. Europace 12:1119–1126
Herrmann-Lingen C, Fritzsche K, Kanwischer H et al (2004) Cardiological and psychosocial status of patients with malignant ventricular arrhythmias before implantation of a cardioverter defibrillator. First results from the German Austrian ICD Multicenter Study (GAIMS). Psychother Psychosom Med Psychol 54:308–319
Crossmann A, Schulz SM, Kuhlkamp V et al (2010) A randomized controlled trial of secondary prevention of anxiety and distress in a German sample of patients with an implantable cardioverter defibrillator. Psychosom Med 72:434–441
Pauli P, Wiedemann G, Dengler W et al (1999) Anxiety in patients with an automatic implantable cardioverter defibrillator: What differentiates them from panic patients? Psychosom Med 61:69–76
Kapa SJ, Rotoondi-Trevisabn D, Mariano Z et al (2010) Psychopathology in patients with ICDs over time: Results of a prospective study. Pacing Clin Electrophysiol 33:198–208
Lüderitz B, Jung W, Deister A et al (1993) Patient acceptance of the implantable cardioverter defibrillator in ventricular tachyarrhythmias. Pacing Clin Electrophysiol 16:1815–1821
Irvine J, Dorian P, Baker B et al (2002) Quality of life in the Canadian Implantable Defibrillator Study (CIDS). Am Heart J 144:282–289
Namerow PB, Firth BR, Heywood GM et al (1999) Quality-of-life six months after CABG surgery in patients randomized to ICD versus no ICD therapy: findings from the CABG Patch Trial. Pacing Clin Electrophysiol 22:1305–1313
Dubin AM, Batsford WP, Lewis RJ, Rosenfeld LE (1996) Quality-of-life in patients receiving implantable cardioverter defibrillators at or before age 40. Pacing Clin Electrophysiol 19:1555–1559
Ladwig KH, Deisenhofer I, Simon H et al (2005) Characteristics associated with low treatment satisfaction in patients with implanted cardioverter defibrillators: results from the LICAD study. Pacing Clin Electrophysiol 28:506–513
Weltgesundheitsorganisation (1991) Internationale Klassifikation psychischer Störungen ICD-10. Huber, Bern
APA (1994) American Psychiatric Association diagnostic and statistical manual of mental disorders, 4. Aufl. Washington, DC
Ladwig KH, Baumert J, Marten-Mittag B et al (2008) Posttraumatic stress symptoms and predicted mortality in patients with implantable cardioverter-defibrillators: results from the prospective living with an implanted cardioverter-defibrillator study. Arch Gen Psychiatry 65:1324–1330
Kutz I, Garb R, David D (1988) Post-traumatic stress disorder following myocardial infarction. Gen Hosp Psychiatry 10:169–176
Flatten G, Hofmann A, Liebermann P et al (2001) Posttraumatische Belastungsstörung. Leitlinien und Quellentext. Schattauer, Stuttgart
Hautzinger M, Bailer M, Worall H, Keller F (1995) Beck-Depressions-Inventar (BDI). Testhandbuch, 2. Aufl. Hans Huber, Bern
Hamilton M (1960) A rating scale for depression. J Neurol Neurosurg Psychiatry 23:56–62
Herrmann C, Buss U, Snaith RP (1995) Hospitral Anxiety and Depression Scale- Deutsche Version (HADS-D). Hans Huber, Bern
Maercker A, Schützwohl M (1998) Erfassung von psychischen Belastungsfolgen: Die Impact of Event Skala- revidierte Version (IES-R). Diagnostica 44:130–141
Salmoirago-Blotcher E, Ockene I (2009) Methodological limitations of psychosocial interventions in patients with an implantable cardioverter-defibrillator (ICD). A systematic review. BMC Cardiovascular Disorders 9:56
Kovacs AH, Eigofsky S, Goff JS et al (2006) Implantable cardioverter defibrillator implant-explant-implant case study: Addressing the psychological adjustment to multiple shocks. Clin Cardiol 29:274–276
Urizar GG, Sears SF, Handberg E, Conti JB (2004) Psychosocial intervention for a geriatric patient to address fears related to implantable cardioverter defibrillator discharges. Psychosomatics 45:140–144
Reddemann L (2004) Psychodynamisch Inmaginative Traumatherapie – PITT – das Manual. Klett-Cotta, Stuttgart
Ehlers A (1999) Posttraumatische Belastungsstörung. Hogrefe, Göttingen
Sears SF, Todaro JF, Urizar G et al (2000) Assessing the psychosocial impact of the ICD: a national survey of implantable cardioverter defibrillator health care providers. Pacing Clin Electrophysiol 23:939–945
Godemann F, Ahrens B, Behrens S et al (2001) Classic conditioning and dysfunctional cognitions in patients with panic disorder and agoraphobia treated with an implantable cardioverter/defibrillator. Psychosom Med 63:231–238
Wittchen HU, Wunderlich U, Gruschwitz S, Zaudig M (1997) Strukturiertes klinisches Interview für DSM-IV. Achse I: Psychische Störungen. Hogrefe, Göttingen
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Ginzburg, D., Tavenaux, M., Sperzel, J. et al. Psychische Störungen nach ICD-Mehrfachschocks und deren psychotherapeutische Behandlung. Kardiologe 5, 114–121 (2011). https://doi.org/10.1007/s12181-011-0331-5
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DOI: https://doi.org/10.1007/s12181-011-0331-5