Psychological vulnerability, ventricular tachyarrhythmias and mortality in implantable cardioverter defibrillator patients: is there a link?

Abstract

Implantable cardioverter defibrillator (ICD) therapy is the first-line treatment for the prevention of sudden cardiac death. Despite the demonstrated survival benefits of the ICD, predicting which patients will die from a ventricular tachyarrhythmia remains a major challenge. So far, psychological factors have not been considered as potential risk markers that might enhance the prediction of sudden cardiac death. This article evaluates the evidence for a link between psychological vulnerability, ventricular tachyarrhythmias and mortality and the pathways that might explain such a link. This review demonstrates that there is cumulative evidence supporting a link between psychological vulnerability and risk of ventricular tachyarrhythmias and mortality in ICD patients independent of disease severity and other biomedical risk factors. It may be premature to include psychological factors in risk algorithms, but information on the psychological profile of the patient may help to optimize the management and care of these patients in clinical practice.

Keywords::

• arrhythmias
• distress
• implantable cardioverter defibrillator
• mechanisms
• mortality
• psychological vulnerability

Financial & competing interests disclosure

This research was supported in part by a VIDI grant (91710393) from the Netherlands Organisation for Health Research and Development (ZonMw) to SS Pedersen, The Hague, The Netherlands. SS Pedersen has received moderate consultancy and speaker’s fees from St. Jude Medical, Sanofi-Aventis, Medtronic and Cameron Health BV in the past and is currently serving as a consultant for Cameron Health BV. H Versteeg has received speaker’s fees from Medtronic. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.