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Terminal illness
Irreversible NYHA class IV congestive heart failure without option of cardiac transplantation
Implantation at time of coronary-bypass surgery performed for primary prevention
Patients’ psychological responses to implantation of a defibrillator are highly variable. In the AVID trial, patients who reported shocks during follow-up also reported reductions in their physical functioning and mental well-being and increased anxiety. In CIDS, adverse effects on the quality of life were observed only in patients who received more than four shocks. In both of these studies, patients who reported having received no shocks also reported a quality of life similar or superior to that reported by subjects receiving antiarrhythmic drugs who had no adverse effects from the therapy.
Follow - Up
Current implantable defibrillators automatically perform necessary periodic capacitor reformation and recharging of the battery to maintain electrical integrity. Patients should be seen at regular intervals to monitor the site of implantation, proper function-ing of the leads and the device, arrhythmia detection, and the delivery of therapy.62,63 The interval between follow-up visits may range between one and six months, depending on the patient’s condition and the length of time since implantation of the defibrillator. Primary follow-up should be con-ducted by or in coordination with an electrophysiologist with experience in defibrillator management.
* Modified from Gregoratos et al., where a full list and description of indications can be found. VT denotes ventricular tachycardia, VF ventricular fibrillation, LV left ventricular, LVEF left ventricular ejection fraction, and NYHA New York Heart Association. Web sites and other technical support services for physicians who have questions concerning patients with defibrillators.
Patients who report single shocks without sequelae can be evaluated by the physician during a routine office visit. Patients who have multiple shocks within a short period (24 to 48 hours) should contact their physicians within 24 hours. Patients and physicians should both be aware that strong electromagnetic fields may interfere with the func-tion of a defibrillator. Malfunctions caused by diagnostic or therapeutic devices that generate electrical current or magnetic fields (e.g., cautery and magnetic resonance imaging) or by the use of motors, appliances, cellular phones, and security and antitheft devices have been reported.
Driving should not be affected by an implanted defibrillator, but patients who have had episodes of severe symptoms or loss of consciousness within the previous six months, whether or not they have an implanted defibrillator, should be advised to refrain from driving.66,67 Many patients resume driving after an interval of less than six months during which they have been free of symptoms.68 Patients must be warned of specific local legal restrictions.