ABSTRACT
This case study details the multidisciplinary approach to a patient who underwent implantable cardioverter defibrillator (ICD) explantation for psychological reasons. The patient was unable to manage the stress associated with multiple shocks. He had a class I indication for an ICD but initially refused to undergo reimplantation. Treatment included the provision of comprehensive medical, nursing, and psychological care, with emphasis on patient autonomy and respect for the patient's experience.
Subject(s)
Adaptation, Psychological , Defibrillators, Implantable/adverse effects , Defibrillators, Implantable/psychology , Adult , Cardiomyopathy, Hypertrophic/therapy , Equipment Failure , Humans , Interdisciplinary Communication , Male , Patient Care , Quality of LifeABSTRACT
Cardiac resynchronization therapy (CRT) is an established adjunctive treatment for patients with systolic heart failure (HF) and ventricular dyssynchrony. The majority of recipients respond to CRT with improvements in quality of life, New York Heart Association functional class, 6-min walk test, and ventricular function. Management of HF after CRT may include up-titration of neurohormonal blockade and an exercise prescription through cardiac rehabilitation to further improve and sustain clinical outcomes. Diagnostic data provided by the CRT device may help to facilitate and optimize treatment. Initial nonresponder rates remain problematic. We suggest a simple step-by-step management and troubleshooting strategy that integrates device function with advanced HF therapy in patients who do not initially respond to CRT. This algorithm represents a new, comprehensive, collaborative approach between the HF and electrophysiology specialists to further improve and sustain outcomes in the field of CRT.