Mental Disorders After Cardiac Implantable Electronic Device Implantation in Young Individuals

BACKGROUND: Increasing use of cardiac implantable electronic devices (CIEDs) has raised concerns about psychological distress in young adults. We evaluated the risk of incident mental disorders after CIED implantation. METHODS: Using the Korean National Health Insurance database, we identified individuals aged 20 to 39 years who underwent health checkups in 2009 to 2012. Those receiving a new CIED within 4 years were included, and controls were selected by 1:5 matching for age, sex, and index year. The primary outcome was a composite of newly diagnosed mental disorders (mood disorders and anxiety/stress-related/somatoform disorders), and secondary outcomes were the individual components. RESULTS: There were 569 CIED recipients (209 pacemakers, 360 implantable cardioverter-defibrillators) and 2821 matched controls analyzed. Over a median follow-up of 5.3 years, both the pacemaker and implantable cardioverter-defibrillator implantations were associated with a significantly higher risk of the primary outcome compared with no device (hazard ratio [HR], 1.63 [95% CI, 1.20-2.21] and HR, 1.80 [95% CI, 1.39-2.35], respectively). In head-to-head analyses, the risk of the primary outcome did not differ significantly between implantable cardioverter-defibrillator and pacemaker recipients (adjusted HR, 1.09 [95% CI, 0.75-1.59]). Risks of secondary outcomes were also increased in both device groups. CIED recipients had a 1.95-fold higher risk of mental disorders within 2 years postimplantation (95% CI, 1.45-2.62), and this elevated risk persisted beyond 2 years (HR, 1.54 [95% CI, 1.13-2.11]). CONCLUSIONS: Among young individuals, both pacemaker and implantable cardioverter-defibrillator implantations were associated with increased risks of mental disorders, supporting proactive psychological screening and interventions.