Managing With Pacemakers and Implantable Cardioverter Defibrillators

Implantable cardioverter defibrillators (ICDs) save lives in patients at risk for sudden death attributable to ventricular arrhythmias, pacemakers (PMs) have been improving symptoms in patients with bradyarrhythmias for decades, and, more recently, cardiac resynchronization devices have improved mortality, morbidity, and quality of life for patients with heart failure.1 However, these devices can also be life-changing for the patients receiving them. The need for long-term follow-up, concerns regarding malfunction, and lifestyle restrictions all affect patients with any implanted device. For patients with ICDs, receiving shocks, both appropriate and inappropriate, can impact quality of life (QOL). Lead or device malfunction can result in unnecessary shocks, and recalls can cause anxiety. Shocks at the end of life can be particularly devastating. However, with careful attention by the healthcare team, both shocks and their impact can be reduced. In addition to shocks, restrictions imposed by the ICD can also impact QOL. The possibility of syncopal arrhythmias and loss of control attributable to shocks, as well, has led to concerns regarding the safety of driving and of sports participation for some individuals, a further burden. Remote monitoring increases the ease of follow-up for patients and physicians and may improve timeliness of management. However, a consequence of remote follow-up has been a decrease in the amount of time electrophysiologists may spend face-to-face with patients, emphasizing the importance of communication between electrophysiologist and primary cardiologist. This article will review ways in which electrophysiologists, general cardiologists, and patients can work together to minimize the burdens that can accompany these devices, often weighing issues of patient QOL, safety, and autonomy. Studies of overall QOL for patients with ICDs have shown mixed results. Some studies have found no significant differences in overall QOL between ICD patients and other cardiac patients,2,3 PM patients, or the general population. …