Psychological indices and phantom shocks in patients with ICD

  • Liza A. Prudente
  • Juanita Reigle
  • Cheryl Bourguignon
  • David E. Haines
  • John P. DiMarco



Some patients with ICDs experience the sensation of a shock in the absence of true therapy (phantom shock). We hypothesize that phantom shocks may be a manifestation of anxiety, depression or PTSD.

Methods and results

All patients over 18 years old with an ICD were eligible to enroll in the study. The first 75 subjects who agreed to participate were enrolled and divided into three groups: ICD patients with phantom shocks (n = 19); ICD patients who had actual shocks (n = 28) and ICD patients who had no shocks (n = 28). During a clinic visit a demographic questionnaire and three psychological rating scales were administered: the Spielberger State–Trait Anxiety Inventory (STAI); the Center for Epidemiologic Studies Depression Scale (CES-D) and the Posttraumatic Stress Checklist (PCL-C). No significant differences between groups were found in gender, race, age, history of MI or cardiac surgery status. Data analysis of the psychological indices using one-way ANOVA showed that the group with phantom shocks had more depression (CES-D p = 0.011) and more anxiety (STAI p = 0.010) than the other groups. Multiple comparisons of group means showed a greater percentage of clinically depressed patients in the phantom shock group than in the other groups.


Patients with phantom shocks are more likely to be clinically depressed and have higher levels of anxiety than other ICD patients, regardless of history of actual shocks.


ICD Shock Phantom shock Anxiety Depression PTSD 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Andrykowski, M. A., Cordova, M. J., Studts, J. L., & Miller, T. W. (1998). Posttraumatic stress disorder after treatment for breast cancer: Prevalence of diagnosis and use of the PTSD Checklist-Civilian Version (PCL-C) as a screening instrument. Journal of Consulting and Clinical Psychology, 66(3), 586–590.PubMedCrossRefGoogle Scholar
  2. 2.
    Bardy, G. H., Lee, K. L., Mark, D. B., Poole, J. E., Packer, D. L., Boineau, R., et al. (2005). Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. New England Journal of Medicine, 352, 225–237.PubMedCrossRefGoogle Scholar
  3. 3.
    Bourke, J. P., Turkington, D., Thomas, Gm. McComb, J. M., & Tynan, M. (1997). Florid psychopathology in patients receiving shocks from implanted cardio-verter defibrillators. Heart, 78, 581–583.PubMedGoogle Scholar
  4. 4.
    Buxton, A. E., Lee, K. L., Fisher, J. D., Josephson, M. E., Prystowsky, E. N., & Hafley, G., for The Multicenter Unsustained Tachycardia Trial Investigators. (1999). A randomized study of the prevention of sudden death in patients with coronary artery disease. New England Journal of Medicine, 341(25), 1882–1890.PubMedCrossRefGoogle Scholar
  5. 5.
    Carroll, D. L., Hamilton, G. A., & McGovern, B. A. (1999). Changes in health status and quality of life and the impact of uncertainty in patients who survive life-threatening arrhythmias. Heart Lung, 28, 251–260.PubMedCrossRefGoogle Scholar
  6. 6.
    Conolly, S. J., et al. (2000). Canadian Implantable Defibrillator Study (CIDS). A randomized trial of the implantable cardioverter defibrillator against amiodarone. Circulation, 101, 1297–1302.Google Scholar
  7. 7.
    Dougherty, C. M. (1995). Psychological reactions and family adjustments in shock versus no shock groups after implantation of internal cardioverter defibrillator. Heart Lung, 24(4), 281–291.PubMedCrossRefGoogle Scholar
  8. 8.
    Dunbar, S., Jenkins, L., Hawthorne, M., & Porter L. (1996). Mood disturbance in patients with recurrent ventricular dysrhythmia before insertion of implantable cardioverter defibrillator. Heart Lung, 25, 253–261.PubMedCrossRefGoogle Scholar
  9. 9.
    Duru, F., Buchi, S., Klaghofer, R., Mattmann, H., Sensky, T., Buddeberg, C., 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(4), 375–379.PubMedCrossRefGoogle Scholar
  10. 10.
    Goodman, M., & Hess, H. (1999). Could implantable cardioverter defibrillators provide a human model supporting the learned helplessness theory of depression? General Hospital Psychiatry, 21, 382–385.PubMedCrossRefGoogle Scholar
  11. 11.
    Hegel, M. T., Griegel, L. E., Black, C., Goulden, L., & Ozahowski, T. (1997). Anxiety and depression in patients receiving implanted cardioverter defibrillator: A longitudinal investigation. International Journal of Psychiatry in Medicine, 27(1), 57–69.PubMedCrossRefGoogle Scholar
  12. 12.
    Herbst, J. H., Goodman, Feldstein, S., & Reilly, J. M. (1999). Health-related quality-of-life assessment of patients with life-threatening ventricular arrhythmias. Pacing and Clinical Electrophysiology, 22(Pt 1), 915–926.PubMedCrossRefGoogle Scholar
  13. 13.
    Herrmann, C., von zur Muhen, F., Schaumann, A., Ulbrich, B., Kemper, S., Wantzen, C., et al. (1997). Standardized assessment of psychological well-being and quality-of-life in patients with implanted defibrillators. PACE, 20, 95–103.PubMedGoogle Scholar
  14. 14.
    Hsu, J., Uratsu, C., Truman, A., Quesenberry, C., McDonald, Km., Hlatky, Ma., et al. (2002). Life after a ventricular arrhythmia. American Heart Journal, 144(3), 404–412PubMedCrossRefGoogle Scholar
  15. 15.
    James, J. E. (1997). The Psychological and emotional impact of living with an Automatic Internal Cardioverter Defibrillator (AICD): How can nurses help? Intensive Critical Care Nursing, 13, 316–323.PubMedCrossRefGoogle Scholar
  16. 16.
    Kowey, P. R., Marinchak, R., & Rials, S. (1993). More things that go bang in the night [letter]. New England Journal of Medicine, 328, 1570–1571.CrossRefGoogle Scholar
  17. 17.
    Luderitz, B., Jung, W., Deister, A., & Manz, M. (1994). Patient acceptance of implantable cardioverter defibrillator devices: Changing attitudes. American Heart Journal, 127(4), 1179–1184.PubMedCrossRefGoogle Scholar
  18. 18.
    Mason, S., & Rowlands, A. (1997). Post-traumatic stress disorder. Journal of Accident & Emergency Medicine, 14, 387–391.Google Scholar
  19. 19.
    McCready, J. M., & Exner, D. V. (2003). Quality of life and psychological impact of implantable cardioverter defibrillators: Focus on randomized controlled trail data. Card Electrophysiol Rev, 7, 63–70.PubMedCrossRefGoogle Scholar
  20. 20.
    Moss, A. J., et al., (Multicenter Automatic Defibrillator Implantation Trial Investigators). (1996). Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. New England Journal of Medicine, 335, 1933–1940.PubMedCrossRefGoogle Scholar
  21. 21.
    Moss, A. J., Zereva, W., Jackson, W., Klien, H., Wilber, D. J., Cannom, D. S., et al. (2002). MADIT II clinical trial. New England Journal of Medicine, 346, 877–883.PubMedCrossRefGoogle Scholar
  22. 22.
    Neel, M. (2000). Posttraumatic stress symptomatology in patients with automatic implantable cardoverter defibrillators: Nature and intervention. Int J Emerg Ment Health, 2(4), 259–263PubMedGoogle Scholar
  23. 23.
    Okun, A., Stein, R. E., Buaman, L. J., & Silver, E. J. (1996). Content validity of the Psychiatric Symptom Index, CES-depression Scale, and State-Trait Anxiety Inventory from the perspective of DSM-IV.Psychological Reports, 79(3 Pt 1), 1059–1069PubMedGoogle Scholar
  24. 24.
    Parkes, J., Bryant, J., & Milne, R. (2000). Implantable cardioverter defibrillators: Arrhythmias. A rapid and systematic review. Health Technology Assess, 4, 1–5.Google Scholar
  25. 25.
    Pauli, P., Wiedmann, G., Dengler, W., Blaumann-Beninghoff, G., & Kuhlkamp, V. (1999). Anxiety in patients with an automatic implantable cardioverter defibrillator: What differentiates them from panic patients? Psychosomatic Medicine, 61, 69–76.PubMedGoogle Scholar
  26. 26.
    Phillips Bute, B., Mathew, J., Blumenthal, J. A., Welsh-Bohmer, K., White, W. D. Mark, D., et al. (2003). Female gender is associated with impaired quality of life 1 year after coronary artery bypass surgery. Psychosomatic Medicine, 65(6), 944–951.PubMedCrossRefGoogle Scholar
  27. 27.
    Prudente, L. A. (2003). Phantom shock in a patient with an implantable cardioverter defibrillator: Case report. American Journal of Critical Care, 12(2), 144–146.PubMedGoogle Scholar
  28. 28.
    Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychology Measurement, 1(3), 385–401.Google Scholar
  29. 29.
    Ritvo, R., Robinson, G., Irvine, F., Brown, L., Murphy, K. J., Stewart, D. S., et al. (1999). A longitudinal study of psychological adjustment to familial genetic risk assessment for ovarian cancer. Gynecologic Oncology, 74(3), 331–337.CrossRefGoogle Scholar
  30. 30.
    Roberts, S. L., & White, B. S. (1990). Powerlessness and personal control model applied to the myocardial infarction patient. Progress in Cardiovascular Nursing, 5(3), 84–94.PubMedGoogle Scholar
  31. 31.
    Schuster, P. M., Philips, S., Dillon, D. L., & Tomich, P. L. (1998). The psychosocial and physiological experiences of patients with an implantable cardioverter defibrillator. Rehabilitation Nursing, 23, 30–37.PubMedGoogle Scholar
  32. 32.
    Shron, E. B., Exner, D. V., Yao, Q., Jenkins, L. S., Steinberg, J. S., Cook, J. R., et al. (2002). Quality of life in the antiarrhythmics versus implantable defibrillators trial: Impact of therapy and influence of adverse symptoms and defibrillator shocks. Circulation, 105, 589–594.CrossRefGoogle Scholar
  33. 33.
    Smith, M. Y., Redd, W., DuHamel, K., Vickberg, S. J., & Ricketts, P. (1999). Validation of the PTSD Checklist-Civilian Version in survivors of bone marrow transplantation. J Trauma Stress, 12(3), 485–499.PubMedCrossRefGoogle Scholar
  34. 34.
    Somervell, P. D., Beals, J., Kinzie, J. D., Boehnlein, J., Leung, P., Manson, S. M. (1993). Criterion validity of the Center for Epidemiologic Studies Depression Scale in a population sample from an American Indian village. Psychiatry Research, 47(3), 255–266.PubMedCrossRefGoogle Scholar
  35. 35.
    Speilberger, C. (1983). State Trait Inventory for Adults. Redwood City, California, Review Set. Mind Garden.Google Scholar
  36. 36.
    Swygman, C. A., Link, M. S., Cliff, D. L., Foote, C. B., Munther, K. H., Wang, P. J., et al. (1998, May 6–9). Incidence of phantom shocks in patients with implantable cardioverter defibrillators. San Diego, California: Abstract presented at North American Society of Pacing and Electrophysiology.Google Scholar
  37. 37.
    The Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators. (1997). Comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. New England Journal of Medicine, 337(22), 1576–1583.CrossRefGoogle Scholar
  38. 38.
    Thomas, S. A., Friedman, E., & Kelley, F. (2001). Living with an implantable cardioverter-defibrilator: A review of the current literature related to psychosocial factors. AACN Clinical Issues, 12(1), 156–163.PubMedCrossRefGoogle Scholar
  39. 39.
    Weathers, F. W., Huska, J. A., & Keane, T. M. (1991). The PTSD Checklist—Civilian Version (PCL–C) (Available from F. W. Weathers, National Center for PTSD, Boston Veterans Affairs Medical Center, 150 S. Huntington Avenue, Boston, MA 02130).Google Scholar
  40. 40.
    Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993). The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. Paper presented at the meeting of the International Society for Traumatic Stress Studies, San Antonio, Texas.Google Scholar

Copyright information

© Springer Science + Business Media, LLC 2006

Authors and Affiliations

  • Liza A. Prudente
    • 1
  • Juanita Reigle
    • 2
  • Cheryl Bourguignon
    • 3
  • David E. Haines
    • 4
  • John P. DiMarco
    • 5
  1. 1.ElectrophysiologyUniversity of Virginia Health SystemCharlottesvilleUSA
  2. 2.Heart Failure ServiceUniversity of Virginia Health SystemCharlottesvilleUSA
  3. 3.Center for the Study of Complementary and Alternative Therapies, School of Nursing, University of VirginiaCharlottesvilleUSA
  4. 4.Heart Rhythm CenterWilliam Beaumont HospitalTroyUSA
  5. 5.Internal MedicineElectrophysiology Service at University of Virginia Health SystemCharlottesvilleUSA

Personalised recommendations