The implantable cardioverter-defibrillator (ICD) has proven to be a life-saving intervention for patients at risk of sudden cardiac arrest. Quality-of-life outcomes for ICD recipients are intricately linked to their ability to effectively cope with ICD shocks. While most individuals can tolerate a shock to some extent, the experience can be discomforting, leading to feelings of anxiety, depression, or fear. This article aims to review strategies for patients and their families to prepare for and respond to ICD shocks, with the goal of minimising the impact of shocks on their overall quality of life.
Understanding Shock
The ICD is designed to continuously monitor and treat cardiac arrhythmias, or abnormal heartbeats. When an abnormal heartbeat is detected, the ICD may deliver small rapid pacing impulses known as Anti-tachycardia Pacing (ATP) to try and rectify the rhythm, some may feel this but it should not be mistaken for a shock. If the ATP can’t rectify the issue a shock may be actioned to restore a normal heart rhythm. Although shocks can be startling and uncomfortable, they are an indicator that the ICD is effectively preventing life-threatening arrhythmias or rapid heart rates. Having a plan in place for responding to shocks can help reduce uncertainty and anxiety, enabling patients and their loved ones to handle shocks appropriately and know when to seek medical assistance.
Preparing for Shock
Education is crucial in preparing for ICD shocks. Understanding the purpose, operation, and response protocols for the ICD can help alleviate anxiety and enhance coping mechanisms. Engaging with local support groups for heart patients or ICD recipients can offer additional insights into cardiac diseases and how the ICD functions to ensure safety. Keeping important information readily accessible, such as the ICD identification card, medication list, and doctor’s contact details, is essential for providing comprehensive care in emergency situations.
An action plan should be established to prepare for ICD shocks. This plan may involve practising responses to shocks, and patients are encouraged to discuss a customised plan with their healthcare provider. A sample action plan is provided to help guide these discussions:
Action Plan
| Event | Symptoms | Action |
|---|---|---|
| Received ICD shock | Feel fine immediately | Contact your ICD clinic to discuss the recent event and schedule the necessary follow-up |
| Received ICD shock | Experiencing chest pain or pressure, shortness of breath, rapid heartbeat, dizziness, confusion, or generally not feeling well. | Seek medical attention immediately |
| Received two or more ICD shocks within 24 hours | Feel fine or ill | Seek medical attention immediately |
Postshock Coping
Experiencing a shock is generally uncomfortable, but a structured response can mitigate both short and long-term negative effects. Effective management involves strategies that engage both the mind and actions. A key strategy is to relax and focus. Shock triggers heightened awareness, but practicing deep-breathing and tension-reduction exercises can counteract this arousal. Positive thinking is emphasised as research indicates that an optimistic attitude can significantly influence the quality of life for ICD patients.
To maintain a fulfilling life, patients are encouraged not to allow fear of shocks to limit their activities. A step-by-step coping to-do list is recommended, including both stress-reducing daily activities and future goals to remain motivated and healthy.
Practical Responses to Shock
If you experience an ICD shock, it is important to stay calm and follow these steps:
1. Check to see if you are okay:
- Make sure that you are not injured and that you can breathe normally.
2. Find a safe place to sit or lie down:
- The shock can cause you to feel lightheaded or dizzy.
3. Follow your action plan:
- This will involve contacting your ICD clinic and possibly getting further medical attention.
4. Keep a record of your shocks:
- This will help your doctor track your condition and adjust your treatment plan as needed.
Psychological Responses to Shock
It is normal to feel scared, anxious, or depressed after an ICD shock. These feelings are often due to the shock itself, as well as the fear of experiencing another shock in the future.
Experiencing an ICD shock can trigger anxiety, fear, and other psychological responses. Implementing coping strategies can help you manage these emotions and improve your overall well-being.
1. Relaxation and Focus:
- When you experience a shock, your body’s natural response is heightened awareness. Practice relaxation techniques, such as deep breathing, to reduce the effects of arousal.
2. Positive Thinking:
- Cultivate a positive attitude by reminding yourself of the positive aspects of your life, relationships, activities, and plans. This can help you maintain hope and a sense of purpose.
3. Postshock Debriefing:
- Discuss the reasons for the shock with your doctor. Adjustments to medications or ICD settings might be necessary to prevent future shocks.
4. Returning to Normal Activities:
- Avoiding activities that have previously triggered a shock may limit your quality of life. Gradually return to your regular activities under your doctor’s guidance.
5. Mental Health Help:
- If you experience prolonged anxiety or other mental health issues regarding your ICD or its shocks seek help from your GP or a counsellor.
Driving Restrictions and Medication Changes
An ICD shock will impact your driving licence because you must suspend driving for a period. The length of suspension will vary from case to case, usually depending on the reason for the shock and remedial action taken.
The cause of the shock may also require changes to your medication. For example, if an abnormal heart rhythm caused the shock, your doctor may prescribe medication to help prevent future shocks. Note that changes in anti-arrhythmic medications will impact your driving licence restrictions.
Your doctor can advise you about any necessary restrictions or changes, but it is your responsibility to carry them out.
Conclusion
An ICD shock can be a startling and uncomfortable experience and serve as a reminder of one’s heart condition. However, it is important to remember that an ICD shock is a sign that your ICD is working properly and is protecting you from a life-threatening arrhythmia. If you experience an ICD shock, it is important to stay calm and follow the steps outlined in this article. Despite the shock experience, individuals can achieve a desirable quality of life.