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INTRODUCTION: As indication for implantable cardioverter defibrillators (ICDs) has expanded, prophylactic implantations have increased. It has been well understood that some ICD recipients have psychological problems. Some of those problems are recognized as maladjustment syndromes.METHODS: We studied 35 ICD recipients regularly followed at outpatient department of Kyushu University Hospital in order to clarify the psychological distress and the quality of their daily lives (QOL). By using questionnaire instruments (SF-8, Beck Depression Inventory, Impact of Event Scale Revised, and State-Trait Anxiety Inventory), we studied their psychological status.RESULTS: Depression, anxiety, and post-stress syndromes existed in 45.5% of the ICD recipients and their QOL was compromised. Female ICD recipients reacted to the stress related to ICD implantation differently from male recipients. Elder ICD recipients had a different way of adjustment from the younger recipients. Various ICD related psychological problems were noted in terms of magnitude and diversity.CONCLUSION: To support ICD recipients both physically and mentally, not only the cardiologists but also specialists from other fields such as psychologists and nurse specialists are needed. Ancillary care must be provided through the support team. Cardiologists who determine whether ICD implantation is required must keep in mind potential psychological sequelae. (J Arrhythmia 2007; 23: 269-276)

BACKGROUND: Implantable cardioverter-defibrillator (ICD) has improved prognosis of patients with fatal arrhythmias and ICD implantation has increased. However, there have been known ICD-related psychological problems and impaired quality of life (QOL). There are still limited studies about gender differences in the response to ICD therapy in Japanese population. This paper compared female and male ICD patients on health-related QOL and psychological factors. The aim of the current study were to examine whether women are at a greater risk of poorer QOL and psychological disturbance. METHODS: We studied consecutive ICD patients (n=179, males: 145, females: 34, mean age: 61±16) with Short Form-8 Health Survey (SF-8), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), and Impact of Event Scale-Revised (IESR). One-way multivariate analysis of variance (MANOVA) was performed to examine the relationship between gender and health-related QOL and psychological factors. RESULTS: Women were younger (53.5±19.3 vs 62.2±14.5, P < 0.05) and less likely to be smoker compared to men (8.8% vs 45.5%, P < 0.001). Women were less likely to have ischemic heart disease (17.6% vs 37.2%, P< 0.05). Majority of patients (62%) had a secondary indication for ICD. MANOVA showed women to have impaired QOL on role physical functioning (P <0.05) and bodily pain (P < 0.05) subscales of the SF-8. When adjusting for older age, female gender was associated with impaired QOL on the physical functioning, role physical functioning, bodily pain, and social functioning subscales. Ischemic etiology was not associated with any of the quality of life subscales. Overall of QOL, women have worse physical component summary (PCS) score (44.3±8.8 vs 48.7±9, P <0.05), but no significant differences in mental component summary (MCS) score. Women have greater BDI score than men (9.3±9.2 vs 5.8±7.4, P <0.05). There were no differences in anxiety-state and anxiety-trait between women and men, as well as IESR score. CONCLUSION: In Japanese population, women and men did not differ on mean QOL score, except for women reporting poorer quality of life on two subscales, role physical functioning and bodily pain. In terms of QOL thoroughly, PCS was worse in women than men. There was high tendency of depression in women than men. These gender difference were similar to that of foreign country. Based on the finding in gender differences, it can be consideration to manage those potential decline of quality of life and psychological problems in ICD patients.