title: Posttraumatic stress and quality of life with the totally subcutaneous compared to conventional cardioverter-defibrillator systems.
abstract: BACKGROUND
  For prevention of sudden cardiac death, the transvenously implantable cardioverter-defibrillator therapy (tv-ICD) is well accepted. The subcutaneous system (S-ICD®) is promising in terms of reducing ICD complications. Nevertheless, the impact of the novel generator position on patients' quality of life (QoL) is yet unknown.
  
  
  OBJECTIVE
  This study aimed at comparing QoL and posttraumatic stress with both systems.
  
  
  METHODS
  60 S-ICD®and 60 case-controlled tv single-chamber ICD patients were asked to respond to three standardized questionnaires. PDS [screening for posttraumatic stress disorders (PTSD)] and PHQ-D (detection of the most predominant psychological disorders) were used to screen for potential mental comorbidities. The SF-12 questionnaire was used to evaluate physical and mental well-being. Groups were compared in terms of QoL and PTSD.
  
  
  RESULTS
  n = 42 (70%) pairs were analyzed (n = 30 male, mean age 44.6 ± 12.2 years). Prior appropriate (p = 0.06) or inappropriate episodes (p = 0.24), ejection fraction (p = 0.28), or underlying cardiac disease did not differ significantly between groups. PDS revealed a PTSD in n = 6 tv-ICD and n = 6 S-ICD®patients (14.3%) equally. In the PHQ-D questionnaire, n = 4 tv-ICD and n = 2 S-ICD®patients fulfilled criteria for a major depression (p = 0.68). Panic disorders (n = 2 tv, n = 0 S-ICD®, p = 0.5), and anxiety disorders (n = 3 S-ICD®, n = 0 tv-ICD, p = 0.24) did not differ between groups. The physical well-being score was 39.9 ± 12.5 in patients with a tv-ICD compared to 46.6 ± 9.9 in S-ICD®patients (p = 0.01). The mental well-being score was comparable in both groups (tv-ICD 51.8 ± 10.8 vs. S-ICD®51.9 ± 10.4, p = 0.95).
  
  
  CONCLUSIONS
  Our case-control study revealed equal or even better physical well-being of patients with the S-ICD®. PTSD occurred in almost 15% of ICD patients irrespective of the type of system.
authors.affiliation: Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital Münster, Albert-Schweitzer Campus 1, 48149, Münster, Germany. julia.koebe@ukmuenster.de.
authors.forename: Julia
authors.identifier: http://orcid.org/0000-0002-5877-352X
authors.initials: J
authors.lastname: Köbe
authors.affiliation: Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Hucklenbroich
authors.affiliation: Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital Münster, Albert-Schweitzer Campus 1, 48149, Münster, Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Geisendörfer
authors.affiliation: Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital Münster, Albert-Schweitzer Campus 1, 48149, Münster, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Bettin
authors.affiliation: Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital Münster, Albert-Schweitzer Campus 1, 48149, Münster, Germany.
authors.forename: Gerrit
authors.initials: G
authors.lastname: Frommeyer
authors.affiliation: Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital Münster, Albert-Schweitzer Campus 1, 48149, Münster, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Reinke
authors.affiliation: Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital Münster, Albert-Schweitzer Campus 1, 48149, Münster, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Dechering
authors.affiliation: Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Burgmer
authors.affiliation: Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital Münster, Albert-Schweitzer Campus 1, 48149, Münster, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Eckardt
mesh_terms: D000328:Adult; D015984:Causality; D015897:Comorbidity; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data; D004554:Electric Countershock / Q000523:psychology* / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006333:Heart Failure / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology*; D006801:Humans; D015994:Incidence; D008297:Male; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D015995:Prevalence; D011788:Quality of Life / Q000523:psychology*; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000523:psychology*; D016896:Treatment Outcome
keywords: Quality of life; Subcutaneous ICD