A prospective 1-year study of changes in neuropsychological functioning after implantable cardioverter-defibrillator surgery.
BACKGROUND
The testing of the implantable cardioverter-defibrillator (ICD), through the induction of repeated episodes of ventricular fibrillation, has been associated with disturbances in cerebral activity and increased levels of cytoplasmic enzymes. However, the neuropsychological outcomes of cerebral changes and their quality-of-life implications are unknown.


RESULTS
Fifty-two ICD recipients completed standardized validated neuropsychological tests 1 to 3 days before ICD surgery and then 6 weeks, 6 months, and 12 months after surgery. They also completed psychometric tests measuring anxiety, depression, and quality of life. Between 31% and 39% of patients showed a significant neuropsychological impairment from their baseline function 6 weeks, 6 months, and 12 months after surgery. Ten percent of patients had late-onset deficits at 12 months only. Frequent areas of impairment were auditory and visual memory and attention. Neuropsychological impairment was not related to mood or quality of life at follow-up, although anxiety and depression predicted reduced quality of life.


CONCLUSIONS
ICD implantation is associated with neuropsychological impairment that dissipates for the majority of recipients after 12 months. Short-term memory function and attention are particularly vulnerable to changes in oxygen during ICD testing. Although anxiety and depression are prevalent, there is little evidence for the direct impact of mood on cognition, and deficits appear not to be associated with reduced quality of life. These results provide evidence for longitudinal outcomes of ICD surgery and have implications for patient rehabilitation and adjustment.
Hallas
Claire N
CN
Royal Brompton and Harefield NHS Trust, United Kingdom. ch372@squ.edu.om
Burke
Julie L
JL
White
David G
DG
Connelly
Derek T
DT
D000339:Affect; D000368:Aged; D001007:Anxiety / Q000453:epidemiology / Q000523:psychology; D001288:Attention; D003072:Cognition Disorders / Q000453:epidemiology* / Q000523:psychology*; D017147:Defibrillators, Implantable / Q000523:psychology* / Q000706:statistics & numerical data*; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009048:Motor Skills; D009483:Neuropsychological Tests; D015995:Prevalence; D011446:Prospective Studies; D011594:Psychometrics / Q000706:statistics & numerical data; D011788:Quality of Life; D014693:Ventricular Fibrillation / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D014706:Verbal Learning