Page 91 - JCBP-2-3

Journal of Clinical and
Basic Psychosomatics Psychological changes in patient with ICD

According to the findings from Holter monitor, the 24-h of VF attack and ICD shock treatment had adversely
total heartbeat was 68637, the fastest heart rate was 74 affected the mental status of the patient; he began to fall
bpm, the slowest heart rate was 42 bpm, the average heart into a state of insomnia and suffered from early awakening,
rate was 53 bpm, and the longest R-R interval was 1.5 s, overthinking, emotional agitation, and negative thoughts.
suggesting sinus bradycardia, occasional atrial premature, On multiple occasions, he had expressed to the doctor that
and ST-segment elevation (Figure 2). Coronary artery he felt uncomfortable and experienced suicidal thoughts.
angiography was performed to exclude coronary heart After excluding the possible causal factors of fever,
disease, and separately, no arrhythmia was induced by infection, electrolyte disturbance, and myocardial injury,
intracavity electrophysiological study (Table S2-S3). the somatization symptoms, anxiety, and depression of
During hospitalization, the patient was reexamined using the patient were evaluated using self-rating scales: SSS
ECG, which suggested early repolarization (Figure 1B), and score = 44; GAD-7 score = 18; PHQ-9 score = 10 (Figure 4,
thus, ICD implantation was recommended for secondary Table S4-S6), which collectively indicate severe anxiety
prevention, but the patient refused and requested and moderate depression. Upon realizing these results,
conservative treatment using medications.
the physician consoled the patient through smart phone.
Over the next 5 years, the patient had endured multiple Parts of the messages are given in the following: “with
episodes of syncope coupled with transient loss of ICD protection, there is no need to be too nervous. If the
consciousness, each lasting from tens of seconds to minutes palpitation or sudden syncope occurs, the ICD will not
before the patient regained consciousness spontaneously. induce shock after the heartbeat returns to normal, unless
Repeated ECG revealed saddle ST-segment elevation in the irregular heartbeat cannot stop by itself.” “Aside from
leads V2 – V6 (Figure 1C and D). The patient had a history the heartbeat problems, other conditions of yours are well
of congenital cleft lip and palate, and his immediate family controlled. The usage of defibrillator plus quinidine will
members had never experienced syncope and SCD events. deliver ample protection to you, so there is no need to be
To avoid recurrence of VF, the patient eventually agreed to depressed.” “We are unable to intervene therapeutically
receive ICD implantation. During postoperative follow-up, if your condition is complicated by gene mutations, but
the patient experienced recurrent VF, and ICD therapy, we can address other external factors to improve your
mainly electric shock therapy, was prescribed. condition.” The patient was prescribed lupentixol melitoxin
Within 3 months after ICD implantation, the patient tablets (delanxin) for controlling anxiety and depression.
felt palpitation and chest tightness and had experienced During the follow-up, the patient showed no recurrence
multiple episodes of shocks. ICD follow-up revealed a total of syncope, and the symptoms of palpitation and chest
of four episodes of VF within the 3 months following ICD tightness were comparatively improved. The patient also
implantation, all of which were cardioverted by means reported no new episodes of VF and shock treatment
of ICD shock therapy (Figure 3). After the second shock complications under ICD programming.
treatment, the patient developed persistent palpitation and 3. Discussion
an inability to raise the left arm after ICD implantation. The
inability to raise the arm after ICD implantation may be ERS and Brugada syndrome are collectively referred
related to electrode displacement, joint adhesion, muscle to as J-wave syndromes. ERS has been considered an
2
atrophy, muscle weakness, and peripheral nerve damage in ECG manifestation with a good prognosis in the past
the arm, but these conditions had never occurred in this decades. With the gradual development of research and
case. Owing to frequent VFs, the patient took quinidine understanding, ESR is found to increase the risk for
3
orally, but despite the drug treatment, he continued to malignancy and related to the occurrence of VF and SCD.
experience recurrent VFs and ICD shocks. Four episodes According to the HRS/EHRA/APHRS Expert Consensus,

Figure 2. ST-segment elevation as shown on the Holter monitor. The ST segment was elevated in a bow-back downward pattern.

Volume 2 Issue 3 (2024) 3 doi: 10.36922/jcbp.2848