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How to Respond to an Implantable Cardioverter-Defibrillator Shock

The implantable cardioverter-defibrillator (ICD) has consistently demonstrated a life-saving benefit in patients at risk for sudden cardiac arrest. Quality-of-life outcomes with the ICD may be directly related to coping successfully with ICD shocks. Although most people are able to tolerate a shock to some extent, the experience of shock is discomforting and can prompt feelings of anxiety, depression, or fear. The purpose of this article is to review patient and family preparations and responses to ICD shock to limit its impact on quality of life.

The ICD provides continuous monitoring and treatment for cardiac arrhythmias (abnormal heartbeats). The ICD automatically detects an abnormal heartbeat and will deliver small rapid pacing impulses or an electric shock to the heart to restore a normal heart rhythm. During the first year after implantation, the chances of receiving at least one ICD shock can range from one third to one half of all ICD recipients.1,2 The shock sensation has been likened to a swift kick in the chest and rated a “6” on a 0 to 10 pain scale.1,3 Nonetheless, quality-of-life research indicates that the ICD is at least equal to or better than antiarrhythmic medications on most indicators of quality of life.2,4–8 Most research has pointed to ICD shock as the primary culprit if reductions in quality of life occur.2

### Psychological Responses to Shock

ICD-specific fears and symptoms of anxiety (for example, excessive worry, increased muscle tension, sweating, and increased heart rate and respiratory rate) are the most common psychological symptoms experienced by ICD recipients, with approximately 13% to 38% of recipients …