Psychological impact of implantable cardiac devices: reassurance or distress?

Background/Objectives Implantable cardiac devices (ICDs, pacemakers, CRTs) substantially reduce morbidity and mortality from life-threatening arrhythmia and heart failure symptoms, but can affect psychological well-being. Prior literature reports heterogenous psychiatric outcomes and several of them have linked ICD shocks to increased anxiety and depression. This study aimed to investigate the impact of implantable devices, particularly ICDs, on symptoms of depression and anxiety. Methods Patients scheduled for PCM or ICD implantation completed the Hospital Anxiety and Depression Scale (HADS) questionnaire before surgery and again six months post-implantation. We evaluated demographic and clinical characteristics, medication use, and any changes in treatment for anxiety or depression after implantation. We also recorded the indication for device implantation, patients’ understanding of the indication, the occurrence of ICD shocks, and their psychological impact in relation to anxiety and depression. Patients were categorized into two groups: ICD implantation and PCM implantation, and comparisons were made between the groups. Results A total of 91 patients underwent ICD implantation (61 men and 30 women; mean age 73 ± 6.5 years). Prior to implantation, 35% were receiving medication for anxiety and 14% for depression and after implantation, 32% were receiving medication for anxiety and 14% for depression. The mean difference in HADS scores before and after implantation was 0.813 for anxiety (95% CI: 0.454–1.172, p < 0.001) and 0.187 for depression (95% CI: −0.28–0.428, p = 0.044), indicating a beneficial effect of ICD implantation on anxiety symptoms, with no clinically significant change in depression. Sixty patients underwent PCM implantation (31 men and 29 women; mean age 73 ± 6.7 years). Before implantation, 18% were receiving medication for anxiety and 13% for depression and after implantation, 17% were receiving medication for anxiety and 13% for depression. The mean difference in HADS scores before and after implantation was 0.383 for anxiety (95% CI: 0.27–0.740, p < 0.001) and 0.233 for depression (95% CI: −0.076–0.543, p = 0.068), indicating no clinically significant differences in anxiety or depression following PCM implantation. Conclusions Patients undergoing ICD implantation demonstrated a significant improvement in anxiety scores six months after implantation, suggesting a beneficial effect of ICDs on anxiety, while no significant change was observed in depression scores. In contrast, patients undergoing PCM implantation showed no significant differences in either anxiety or depression. These findings suggest that patients, particularly those receiving ICDs for secondary prevention, may feel safer after implantation, despite the common perception that ICD recipients often require additional psychological support.