Citation

Chang YW, Chen JY. J. Geriatr. Cardiol. 2021; 18(4): 312-315.

Copyright

(Copyright © 2021, Institute of Geriatric Cardiology, Chinese PLA General Hospital)

DOI

10.11909/j.issn.1671-5411.2021.04.010

PMID

33995511

Abstract

There is consensus regarding the efficacy and safety of permanent pacemakers (PPM) and other cardiac implantable electronic devices. These devices improve the quality of life by reliving symptoms of bradycardia including dizziness, fatigue and exercise intolerance. The decision to implant a PPM is often made at the time of the initial encounter with the patient, such as when symptomatic bradyarrhythmia is first diagnosed. The implantation procedure is usually performed promptly. However, the psychosocial factors related to having a PPM are frequently underestimated by clinicians. Poor psychological adaption after implantation, particularly among aged patients with undetected psychiatric illness, poses a significant risk to treatment benefit. It is known that both anxiety and depression commonly accompany cardiovascular disease (CVD), leading to reduced quality of life and increased mortality. Depressed elder adults tend to present different symptoms from the young patients, such as somatic symptoms, loss of interest and cognitive changes.[1] Currently, a psychological evaluation before and after PPM implantation is not generally advocated. In this article, we propose that shared decision-making (SDM), employing psychosocial approaches, is critical for aged patients receiving permanent pacing therapy, if successful outcomes are to be maximized.

An 87-year-old woman was brought to our emergency department with an extensive self-inflicted wound of the left upper chest wall, exposure of a pacemaker generator with damaged leads, and self-lacerations of both wrists. A permanent pacemaker system (DDDR mode, ADAPTA, Medtronic) had been implanted eight years previously...

Language: en