title: Pre-hospital discharge testing of defibrillator without anesthesia: effects on psychological symptoms during clinical follow-up.
abstract: OBJECTIVE
  After the implantation of an implantable cardioverter-defibrillator (ICD), patients often fear therapeutic shock. The extent to which the experience of pre-hospital discharge (PHD) testing without anesthesia after ICD implantation, under observation by a physician, affects shock-related anxiety symptoms on follow-up has not been investigated as yet.
  
  
  METHODS
  In a prospective, randomized controlled trial, 44 patients with a primary prevention indication for an ICD were randomly assigned to experience PHD testing without anesthesia (n = 23) or with anesthesia (n = 21). Patients were longitudinally evaluated before (T(1)), shortly after (T(2)), and 3 months after (T(3)) PHD testing. During the respective PHD testings, the course of patients' serum cortisol release was measured.
  
  
  RESULTS
  During PHD testing, patients without anesthesia showed a significantly higher serum cortisol release than patients with anesthesia (F(4,152) = 22.227, p < .001). Patients who experienced PHD testing without anesthesia felt significantly safer with the ICD (U = 165.000, p = .040), would significantly more often recommend other patients to undergo PHD testing without anesthesia (χ(2) = 12.013, p = .002), and showed significantly lower levels of general shock-related anxiety shortly afterward (F(1,42) = 6.327, p = .02) and 3 months after PHD testing (F(1,41) = 8.603, p = .005).
  
  
  CONCLUSIONS
  The implementation of PHD testing without anesthesia is associated with lower anxiety concerning therapeutic shock. Patients should be advised about the effects of PHD testing without anesthesia on their psychological well-being in the long run.
authors: Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany. katja.petrowski@tu-dresden.de
authors: Katja
authors: K
authors: Petrowski
authors: Gloria-Beatrice
authors: GB
authors: Wintermann
authors: Christian
authors: C
authors: Petzold
authors: Ruth H
authors: RH
authors: Strasser
authors: Michael
authors: M
authors: Guenther
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia; D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D059031:Anticipation, Psychological; D001007:Anxiety / Q000097:blood / Q000517:prevention & control* / Q000523:psychology; D017147:Defibrillators, Implantable / Q000009:adverse effects / Q000523:psychology*; D004554:Electric Countershock / Q000295:instrumentation / Q000379:methods / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D015742:Propofol / Q000627:therapeutic use; D011446:Prospective Studies; D013315:Stress, Psychological / Q000097:blood / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D018686:Anesthetics, Intravenous; D006854:Hydrocortisone; D015742:Propofol
keywords: anesthesia during test shock; anxiety disorders; implantable cardioverter-defibrillator; pre–hospital discharge testing; psychological well-being; shock-related anxiety