Recollection of pain due to inappropriate versus appropriate implantable cardioverter‐defibrillator shocks

GM Marcus, DW Chan… - Pacing and clinical …, 2011 - Wiley Online Library
GM Marcus, DW Chan, RF Redberg
Pacing and clinical electrophysiology, 2011Wiley Online Library
Background: Although inappropriate shocks are known to be an important consequence of
implantable cardioverter‐defibrillators (ICDs), the subjective experience of pain intensity
perceived by those receiving inappropriate versus appropriate shocks has not previously
been examined. Methods: One hundred ICD patients underwent a standardized interview by
an investigator blinded to the clinical history. Patients with a previous ICD shock were asked
to describe the intensity of the associated pain on a standard 0–10 scale (10 being the worst …
Background: Although inappropriate shocks are known to be an important consequence of implantable cardioverter‐defibrillators (ICDs), the subjective experience of pain intensity perceived by those receiving inappropriate versus appropriate shocks has not previously been examined.
Methods: One hundred ICD patients underwent a standardized interview by an investigator blinded to the clinical history. Patients with a previous ICD shock were asked to describe the intensity of the associated pain on a standard 0–10 scale (10 being the worst pain they had ever experienced). Medical charts were then examined for any history of inappropriate and/or appropriate ICD discharges.
Results: Thirty‐five of the 100 patients had a record of at least one ICD shock, and 17 had experienced at least one inappropriate shock. Those with a history of an inappropriate shock described a significantly higher median pain scale (9, interquartile range [IQR] 8–10) compared to those with a history of only appropriate shocks (median 4, IQR 2–8, P = 0.0011). In multivariable analysis, a history of an inappropriate shock was the only predictor statistically significantly associated with an increase in shock pain: the pain scale for those with inappropriate shocks was higher by 2.8 points on average after multivariable adjustment (95% confidence interval 0.29–5, P = 0.030). Eighteen patients had considered having their device deactivated, and a history of an inappropriate shock was the only factor independently associated with this consideration.
Conclusions: Compared to those who have received only appropriate shocks, inappropriate ICD shocks are associated with a recollection of greater pain and consideration of device inactivation. (PACE 2011; 34:348–353)
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