No description available.

Šiame darbe apžvelgiama Vilniaus Universiteto Širdies ligų ir kraujagyslių klinikoje 1991−2008 metais sukaupta patirtis taikant nemedikamentinį gydymą pacientams su supraventrikulinėmis tachikardijomis ir skilveliniais ritmo sutrikimais. Apibendrinome nemedikamentinio gydymo rezultatus 1693 pacientams: 753 pacientams su atrioventrikulinio mazgo paroksizmine tachikardija, 657 pacientams su papildomais laidumo takais, 169 pacientams su skilvelinėmis tachikardijomis. Be to, apibendrinome kardioverterių defibriliatorių implantavimo rezultatus 118 pacientų. Nustatėme, kad atrioventrikulinio mazgo tachikardijos kateterinės abliacijos efektyvumas 99,2%, komplikacijų dažnis 0,53%. Įrodėme, kad saugu atlikti „lėtos“ zonos abliaciją pacientams su ilgu PQ intervalu. Papildomų laidumo takų kateterinė abliacija buvo efektyvi 98,1% atvejų, komplikacijų dažnis 1,7%. Papildomų laidumo takų grupėje sudėtingiausios lokalizacijos yra užpakalinė pertvarinė dalis ir vidurinė pertvarinė dalis (pastaroji – dėl rizikos sukelti III laipsnio AV blokadą). Skilvelinių tachikardijų kateterinės abliacijos rezultatas priklauso nuo etiologijos. „Idiopatinių“ skilvelinių tachikardijų atvejais kateterinės abliacijos efektyvumas viršija 90%. Koronarinės širdies ligos ir kardiomiopatijų atvejais kateterinė abliacija mažiau efektyvi (~60%). Kardioverterių defibriliatorių grupėje iki 11 m. stebint pacientus, defibriliatorius suveikė 68,6% atvejų. / This paper reviews the 1991−2008 experience with non-pharmacological treatment of supraventricular and ventricular tachycardias in the Clinic of Heart and vessel diseases of Vilnius University. We summarized the results of managing 1693 patients: 753 patients with atrioventricular nodal tachycardia, 657 patients with accessory pathways, 169 patients with ventricular tachycardias, and 118 patients with implanted cardioverter defibrillators. We have shown that the success rate of catheter ablation for atrioventricular nodal tachycardia is 99.2% with complication rate 0.53%. The safety of ablating the “slow” pathway in patients with prolonged PQ interval has been shown. The success rate of catheter ablation of accessory pathways is 98.1% with 1.7% complication rate. The most complex accessory pathway localization for ablation was posteroseptal area and midseptal area (the latter because of the risk to induce a complete atrioventricular block). The result of catheter ablation for ventricular tachycardia depends on etiology. For “idiopathic” ventricular tachycardias success rate exceeds 90%. In patients with coronary heart disease and cardiomyopathies, catheter ablation is less effective (60%). During the follow-up with duration up to 11 years, 68.6% of patients with implanted cardioverter defibrillators have experienced therapy delivered by the device.

Abstract Introduction: The perception of quality of life (QoL) in patients with implantable cardiac devices including implantable cardioverter-defibrillators (ICD), followed by telemonitoring care (Home Monitoring HM), has recently become an extremely hot topic due to constantly increasing number of patients wearing these devices. This increase has resulted in an increased demand for safe, prompt, and more effective out-patient care. Methods: Our research was carried out between December 2016 and March 2017. A cohort of 150 consecutive patients with ICD, followed using the Home Monitoring system (HM+), and 150 consecutive patients with ICD, followed using conventional in-office check-ups (HM-), was retrospectively drawn from the Ceske Budejovice Hospital Patient Information System. A questionnaire, which specifically addressed QoL (EQ5D), level of anxiety and depression (HADS), and a custom questionnaire examining the relationship between patients and the HM system and telecare workflow, was sent out to all patients. Results: For the final statistical analysis, 91 (60.7%) and 104 (69.3%) of the questionnaires were used from the HM+ and HM- groups, respectively. Our results showed that the method of ICD device follow-up did not directly influence QoL. Our statistical comparison of the data did not show any difference between HM+ and HM- patients. A non-significant trend towards better QoL in HM+ compared to HM- patients was noted based on total QoL scores from the EQ5D questionnaire (68.6 ? 19 vs. 64.6 ? 16.5, p = 0.09). Regarding anxiety and depression, statistical testing also failed to find any difference between HM+ and HM- patients. However, more than half of the patients in both groups were in the "normal" population range with respect to anxiety and depression. The most striking difference between HM+ and HM- patients was noted in the preference for the type of follow-up: while 54.9% of HM- patients expressed an interest in remote follow-up and 45.1% said they preferred in-office check-ups, only 6.7% (p < 0.0001) of HM+ patients expressed an interest in switching to in-office check-ups with personal contact instead of remote monitoring. Willingness to partially cover the financial costs of telecare was similar in both groups. HM+ patients were more inclined to use remote ICD monitoring (p = 0.007) and had a more positive attitude toward the telecare approach overall, compared to HM- patients (p = 0.034). Conclusion: The method of device follow-up does not significantly affect QoL in patients with ICD devices, nor does it affect levels of anxiety and depression. Generally, patients with ICDs followed using the HM system were very satisfied with telecare and would prefer not to lose remote ICD monitoring. Although, the willingness to, at least partially, cover the costs of the HM system was limited and comparable to that of patients receiving conventional follow-up.

O cardioversor-desfibrilador implantável (CDI) é um dispositivo eletrônico utilizado no tratamento de pacientes com episódios ou risco de parada cardíaca. Tem a capacidade do monitoramento contínuo do ritmo cardíaco para o reconhecimento de arritmias fatais e o consequente disparo de choques para revertê-las. Esses choques elétricos são classificados como apropriados quando o disparo ocorre em decorrência de arritmia potencialmente fatal, ou inapropriados quando o CDI dispara o choque em função de interpretação incorreta dos batimentos cardíacos. Em geral, ocorrem com o paciente consciente provocando desconforto inesperado, geralmente de forte intensidade. A maneira como o paciente vivencia tais acontecimentos, suas reações e sua capacidade de enfrentamento diante de situações inesperadas influenciam de forma relevante sua adaptação à doença e ao CDI. Além disso, o dispositivo é um objeto estranho alojado dentro do corpo, que remete a falha no funcionamento cardíaco, podendo despertar sentimentos ambivalentes e dificuldade de elaboração. Assim, o principal objetivo desse estudo foi descrever e compreender como os pacientes entrevistados vivenciaram e se adaptaram ao implante do CDI a partir das quatro variáveis possíveis relacionadas ao funcionamento do dispositivo: ausência de choques, presença de choques apropriados, presença de choques inapropriados e presença de choques mistos (apropriados e inapropriados). Para tanto, foi utilizado o método clínico-qualitativo. Foram realizadas entrevistas semi-estruturadas com 4 pacientes submetidos ao implante de CDI que representam cada uma das variáveis. Os critérios de inclusão foram pacientes do sexo masculino, com cardiopatia isquêmica prévia, implante do CDI como prevenção primária ou secundária de morte súbita cardíaca (MSC), idade entre 50 e 70 anos e dispositivo implantado há, pelo menos, dois anos. Todos os pacientes foram selecionados no ambulatório da Unidade Clínica de Estimulação Cardíaca Artificial do Instituto do Coração HC-FMUSP (Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo). Os dados foram analisados a partir do referencial Piscossomático e Psicanalítico Freudiano e categorizados posteriormente pela Escala Diagnóstica Adaptativa Operacionalizada Revisada (EDAO-R). Os resultados demonstraram que a adaptação, segundo o conceito utilizado, ao impacto do CDI e do choque está diretamente ligada ao impacto do IAM e do adoecimento como um todo, e as reações dos pacientes diante dos diferentes episódios parecem análogas evidenciando que só é possível compreender as repercussões psíquicas relativas ao CDI a partir da compreensão das repercussões causadas pela doença que levou o paciente a ter o dispositivo implantado. Um paciente demonstrou estar adaptado ao adoecimento e ao CDI, embora não tenha vivenciado episódios de choque, e os outros três pacientes demonstraram estar em processo de adaptação, vivenciando conflitos psíquicos que influenciam sua capacidade adaptativa. Existem evidências de que, se intervenções psicológicas e informativas forem adotadas, esse processo ocorrerá de maneira mais eficaz / The implantable cardioverter - defibrillator (ICD) is an electronic device used to treat patients with episodes or risk of cardiac arrest. It is able to continuously monitor of the patients heart rate for the recognition of fatal arrhythmias and the consequent triggering of shocks to reverse them. These electric shocks are classified as appropriate when the triggering occurs due to potentially fatal arrhythmias or inappropriate when the ICD fires the shock due to incorrect interpretation of the heart beat. In general, the shocks occur while patients are conscious, thus causing unexpected discomfort of strong intensity. The way the patient experiences such events, their reactions and their ability to cope with unexpected situations substantially influence their adaptation to the disease and to ICD. Furthermore, the device is a foreign object lodged inside the body, which refers to a malfunction of the heart and may arouse ambivalent feelings and difficulty of adaptation. Thus, the main objective of this study was to describe and understand how surveyed patients experienced and adapted to ICD implantation from the four variables related to operation of the device: the absence of shocks, the presence of appropriate shocks, the presence of inappropriate shocks and presence of (appropriate and inappropriate) mixed shocks. In order to carry out the study, the clinical-qualitative method was used. Semi-structured interviews were conducted with 4 patients undergoing ICD implantation that represent each variable. Inclusion criteria were male patients with previous ischemic heart disease, ICD implantation as primary or secondary prevention procedure of sudden cardiac death (SCD ), aged between 50 and 70 years who had the implanted device for at least two years. All patients were selected from the outpatient clinic of the Clinical Unit of Cardiac Pacing of the Heart Institute - HC - USP (Hospital das Clinicas, Medical School, University of São Paulo). Data were analyzed having the Psychosomatic and Freudian Psychoanalytic referential and subsequently categorized by the Revised Operational Adaptive Diagnostic Scale (ROADS). The results have shown that adaptation (according to the concept used) to the impact of ICD and shock is directly linked to the impact of AMI and to the disease as a whole and that the reactions of patients on the different episodes seem analogous, showing that you can only understand psychic repercussions on the ICD from the understanding of the effects caused by the disease that led the patient to have the device implanted. One of the patients proved to be adapted to the illness and the ICD, although he has not experienced episodes of shock while the other three patients demonstrated to be somewhere along the adaptation process, having experienced psychic conflicts that influence their adaptive capacity. There is evidence that if psychological interventions are adopted, this adaptation process will occur much more effectively

Introdução: Ansiedade, depressão, personalidade Tipo D e terapias de choque do cardioversor-desfibrilador implantável (CDI) são fatores de risco para pior ajuste psicossocial. Além da maior parte dos estudos serem realizados em países desenvolvidos, pouca atenção é dada a estes e outros fatores, assim como à influência na percepção de portadores de CDI quanto à sua cardiopatia de base. Estratégias de enfrentamento, diferença entre percepção do CDI e da doença, assim como percepção dos familiares também têm sido negligenciadas. Os objetivos deste estudo foram descrever o perfil psicossocial de portadores de CDI em nosso meio, avaliar a relação entre os fatores de risco supracitados, percepções do paciente quanto à doença cardíaca e CDI, a relação entre ocorrência e frequência das terapias de choque do CDI e a compreensão e percepção de familiares em relação ao CDI. Método: 250 portadores de CDI foram avaliados (54.10 ±15.15 anos, 67% sexo masculino) quanto à percepção de doença (Questionário Breve de Percepção de Doença [B-IPQ]); ansiedade, depressão, distress (Escala Hospitalar de Ansiedade e Depressão [HADS]); personalidade Tipo D (DS-14); ocorrência e frequência de choques do CDI desde implante e estratégias de enfrentamento. Representações emocionais e compressão de familiares dos pacientes também foram medidas. A análise estatística utilizou os métodos de Mann-Whitney, Wilcoxon e X2. Resultados: Noventa e nove pacientes (39,6%) apresentaram ansiedade, 62 (24.8%) depressão; 85(34%) distress, 84(34%) personalidade Tipo D e 72(29%) perceberam a doença cardíaca como ameaça. Ansiedade, distress, depressão e personalidade Tipo D foram associadas à percepção de cardiopatia como ameaçadora, OR=11 (p= <. 0001); 7.4 (p= <. 0001); 5.3 p= <. 0001); e 2.9 (p= 0.0001), respectivamente. A percepção da doença cardíaca como ameaça também foi influenciada pela presença de choques do CDI desde o implante, com OR= 2.2 (p= 0.007), 2.1 para >=3 choques em 24 horas (p= 0.03) e 2.4 para >= 5 choques desde o implante (p= 0.008). Pacientes ansiosos e Tipo D foram associados a pior percepção de doença, considerando: 1 - fortes crenças sobre consequências mais graves da doença; 2 - não serem capazes de controlar a doença; 3 - atribuem maior número de sintomas à doença; 4 - são mais preocupados e apresentam mais emoções negativas. As percepções de pacientes com distress ou depressivos são mais negativas em todas as subescalas, exceto compreensão. A maioria dos pacientes (68%) utilizou estratégias de enfrentamento focadas na emoção. Vinte e cinco por cento dos pacientes reportaram limitação imposta pela doença, enquanto 75% se sentiram limitados pelo CDI. Pacientes perceberam mais consequências negativas da doença que do CDI. Familiares apresentaram desgaste emocional e baixa compreensão quanto o uso e funcionamento do CDI. Conclusões: Portadores de CDI assistidos em hospital terciário de atenção cardiológica apresentaram: Elevada taxa de ocorrência de ansiedade; depressão, distress, personalidade Tipo D e percepção de doença como ameaça; Limitação das atividades da vida diária como a maior demanda vivenciada; Cardiopatia de base afetando mais a vida que o CDI, mas a maioria considerando o choque do CDI aversivo. Implicação: Intervenções psicossociais específicas são essenciais para melhor ajustamento de portadores de CDI e seus familiares / Introduction: Anxiety, depression, Type D personality, and implantable cardioverter-defibrillator (ICD) shocks are well-known risk factors for psychosocial maladjustment. Despite the fact that most of the studies were conducted in well-developed countries, little attention has been given to these and others factors and their influence on ICD patients\' perceptions of their heart disease. Coping strategies, the differences between ICD patient and heart disease patient perceptions, and the perception of family members has also been neglected. This project was aimed at describing the psychosocial profile of Brazilian ICD patients and evaluating the relationship between the aforementioned risk factors and patient perceptions about their heart disease and ICD, the temporal relation between occurrence and frequency of ICD shocks, and the understanding and perception of family members regarding the ICD. Methods: 250 ICD patients were evaluated (54.10 ±15.15 years, 67% male) regarding illness perception (Brief Illness Perception Questionnaire [B-IPQ]); anxiety, depression, distress (Hospital Anxiety and Depression Scale [HADS]); Type D personality (DS-14); occurrence and frequency of ICD shocks since implantation; and coping. Family members\' comprehension and emotional representations of the ICD were also assessed. Mann-Whitney, Wilcoxon and X2 were used for statistical analysis. Results: Ninety-nine patients (40%) had anxiety, 62 (25%) depression; 85 (34%) distress, 84 (34%) Type D personality, and 72 (29%) perceived the heart disease as a threat. Anxiety, distress, depression, and Type D personality were associated with perceiving heart disease as a health threat with odds ratios of 11 (p= <.0001); 7.4 (p= <.0001); 5.3 (p= <.0001); and 2.9 (p= 0.0001), respectively. Patients\' perceptions of their heart disease as a threat were also influenced by ICD shocks since implantation with odds ratios of 2.1 (p= 0.007), of 2.1 for >=3 shocks in 24 hours (p= 0.045) and of 2.4 for >= 5 shocks since implantation (p= 0.043). Anxious and Type D patients were also associated with poorer illness perceptions regarding: 1 - strong beliefs about more serious consequences of the illness; 2 - not being capable of controlling the disease on their own; 3 - a greater number of symptoms attributed to the illness; 4 - more concerns and negative reactions. Distressed or depressive patients\' perceptions are more negative on every item of the scale except for understanding. The majority of patients (68%) used emotion focused coping mechanisms. Twenty-five percent of the patients reported feeling limited by heart disease, while 75% reported feeling limited by having the ICD in place. Patients perceived more negative consequences with heart disease than with ICD placement. Family members manifested distress about the ICD and misunderstanding regarding its purpose and function. Conclusions: ICD patients treated in a tertiary heart center presented with incresead frequency of anxiety, depression, distress, Type D personality, and perception of their illness as threat. Limitation of activities of daily living was the most common complaint. Heart disease was reported as more debilitating than the ICD itself, but most patients still considered the device\'s shock aversive. Implication: Specific psychosocial interventions are essential for better adjustment of ICD patients and their families after ICD placement

Background. Primary and secondary prevention trials have shown that implantable cardioverter-defibrillators (ICD) reduce the risk of cardiac death, but concerns have been raised regarding the psychological well-being of ICD patients. Anxiety can affect a significant proportion of these patients, but there is limited information about prevalence and determinants of anxiety after the implementation of the more recent guidelines for ICD implantation. Several behavioral interventions have been effective in improving anxiety in these patients, however the efficacy of mindfulness-based interventions (MBI) has not been investigated in ICD patients, and there is limited information regarding the characteristics of pre-intervention, “dispositional” mindfulness in patients with cardiovascular disease never exposed to mindfulness training. The aims of this dissertation project were: 1) To determine the feasibility of a randomized clinical trial of a phone-administered, mindfulness-based training program, as measured by recruitment and retention rates, treatment adherence and fidelity; 2) To evaluate the current baseline prevalence and determinants of anxiety in the study population and 3) To describe the correlates of dispositional mindfulness in the study population. Methods. The study was conducted at the Electrophysiology Service at the UMass Memorial Medical Center. All consecutive patients who recently underwent an ICD procedure or received ICD shocks were screened for eligibility to participate in a pilot randomized controlled trial in which an eight session, phone-delivered, weekly MBI was compared to a usual care condition. Assessments were performed at baseline and post-intervention. A cross-sectional design was used for aims 2 and 3. Anxiety was assessed using the Hospital Anxiety and Depression Scale; a shortened version of the Five Facets of Mindfulness questionnaire was used to evaluate mindfulness. Results. Thirty patients (21 M, 9 F; mean age 63.1 ±10.3 years) were enrolled in the study. The methods ultimately adopted to screen, recruit, and retain study participants were feasible to conduct and satisfactory to ICD outpatients, and the study intervention was safe. Phone delivery resulted in excellent retention rates and limited costs. Assessments of treatment fidelity showed that the content of the intervention was delivered as intended in almost 100% of cases. The study findings do not show a decrease in the overall prevalence of anxiety in ICD patients compared with earlier cohorts; anxiety was associated with young age, low socio-economic status and previous psychological morbidity, but not with ICD-related factors including prior shock delivery. Finally, baseline mindfulness was most strongly associated with previous psychological morbidity (in particular, depression), and current anxiety symptoms. Conclusion. Psychological morbidity appears to be the major determinant of anxiety in the patients currently enrolled in the study. Dispositional mindfulness is inversely associated with current anxiety and depression and with prior psychological morbidity, supporting the hypothesis of a modulating role of mindfulness on the processing of negative emotions. A phone-delivered, individual MBI is feasible, acceptable to patients and can be adequately delivered by trained instructors. The findings from this dissertation work support the need for larger clinical trials of MBI in ICD patients.

Pulmonary edema occurs when fluid leaks from the pulmonary capillary network into the lung interstitium and alveoli. When the heart is not able to pump blood to the body efficiently, fluid can back up into the veins that take blood through the lungs to the left atrium. This then builds up the pressure in the blood vessels and fluid is pushed into the alveoli in the lungs. The fluid reduces normal oxygen movement through the lungs and can cause impaired gas exchange and respiratory failure. There are many causes of congestive heart failure that may lead to pulmonary edema such as heart attack, any diseases of the heart that weaken or stiffen the heart muscle, a leaking or narrowed heart valve, and sudden, severe high blood pressure. Pulmonary edema is a strong indicator of congestive heart failure in patients and therefore can be used as a gauge for congestive heart failure. One way to diagnose cardiogenic pulmonary edema constantly is through the continuous monitoring of the transthoracic impedance throughout the day. One method to achieve this constant monitoring is through the use of a cardiac pacemaker or an implantable cardioverter defibrillator (ICD). Many patients who are at risk of heart failure have these medical devices implanted already. In these implantable cardiac devices, the connected cardiac leads can be utilized to continually screen several impedance vectors for decreases in impedance in the thoracic cavity. A pacemaker or ICD that implements Pulmonary Edema Monitoring is designed to continuously monitor these impedance vectors and alert the patient to seek medical attention. This thesis will discuss the implementation of Pulmonary Edema Monitoring via screening of multiple impedance vectors in a pacemaker or implantable cardioverter defibrillator and the effectiveness of this monitoring method. Furthermore, the design, implementation, and testing of this feature will be explored in greater detail.

Vinte e seis pacientes com cardiomiopatia hipertrófica e fatores de risco de morte súbita, foram submetidos a implante de cardioversor-desfibrilador implantável de dupla-câmara, com seguimento médio de 19 meses. Observou-se quatro choques em arritmias letais, 4 pacientes apresentaram TVNS e 5 taquiarritmias supraventriculares. Ocorreu um óbito.Conclusões: Observamos: TPSV em 19,2%; TVNS em 15,4% e TVS/FV em 15,4%. Nenhuma variável clínica ou demográfica, discriminou o comportamento clínico ou funcional pós-implante de CDI; a recorrência de síncope pós implante de CDI, não se associou à presença de eventos arrítmicos e a hipertrofia maior que 30 mm se associou à choque precoce do CDI (p=0,003). / During 19 months of average follow-up period, we followed 26 patients with hypertrophic cardiomyopathy and high risk for sudden death, all treated by dual chamber implantable cardioverter-defibrillator. 4 patients had received appropriate ICD discharge, 4 patients with NSVT and 5 supraventricular arrhythmias. One death had occurred. Conclusions: we observed: supraventricular arrhythmias in 19,2%; NSVT in 15,4% and VT/VF in 15,4%. The clinical or demographic outcomes did not suggest any clinical or functional results after ICD implantation; syncope may occur after ICD implantation and no arrhythmias recordered by intracardiac electrograms and left-ventricular-wall thickness greater than 30 mm is associated with early ICD shocks (p=0,003).

O objetivo desse estudo foi avaliar os efeitos da administração prévia de antibiótico na incidência de complicações infecciosas em procedimentos de estimulação cardíaca artificial. Os pacientes foram selecionados em um estudo duplo-cego e randomizado (1:1). Grupo I Cefazolina (1,0g dose única) versus grupo II placebo. O comitê de segurança interrompeu o estudo após a inclusão de 649 pacientes devido à diferença entre os grupos (group I 314; grupo II 335 pacientes) em favor do uso de antibiótico: 2 infectados (0,63%) versus 11 infectados no grupo placebo (3,28%); p=0,016. Marcadores identificados por análise univariada: não uso de antibiótico; procedimentos de implantes (versus trocas); hematoma pós-operatório e duração do procedimento. O não uso de antibiótico e hematoma pós-operatório foram significantes em análise multivariada / The objective of this study was to evaluate the effects of the previous venous antibiotic administration in the incidence of infectious complications in cardiac stimulation surgical procedures. Patients were selected in a double blind, randomized (1:1) trial. Group I Cefazolin (1,0g one dose) versus group II placebo. The security committee interrupted the trial after inclusion of 649 patients due to differences between groups (group I 314; group II 335 patients) in favor of the antibiotic arm: 2 infected patients (0,63%) versus 11 infected patients in the placebo arm (3,28%); p=0,016. Markers identified by univariate analysis: non-use of preventive antibiotic; implant procedures (versus replacement); post-operative haematoma and procedure duration. The non-use of antibiotic and the post-operative haematoma were independent predictors of infection in multivariate analysis

Text in English / International studies have demonstrated that Implantable Cardioverter Defibrillators (ICDs) can have a significant impact on the Quality of Life (QOL) of patients. This is often due to factors that cause considerable psychological distress and has not been investigated in South Africa before. This research study thus investigated factors that influence QOL in patients with ICDs who are followed up in the Cardiac Clinic at Groote Schuur Hospital. The objectives were to describe demographic, clinical, ICD and patient support characteristics; to determine the prevalence of anxiety and depression; to assess QOL and to establish factors that influence depression, anxiety and QOL. The method involved a quantitative approach and a descriptive, cross-sectional and correlational design. All eligible patients with ICDs from the Cardiac Clinic were invited to participate. Participants completed a Demographic and Clinical Questionnaire, the Hospital Anxiety and Depression Scale (HADS) and the SF-36v2 Health Survey. A descriptive analysis of frequencies and summary statistics were done, followed by a regression, comparison and correlational analyses. A total of 70 patients (57 years mean, 65% male) participated in the study. The HADS mean score for anxiety was 6.50, SD 4.52 and for depression 4.96, SD 3.36. The SF-36v2 QOL Physical Component Summary (PCS) mean score was 43.83, SD 9.43 and the Mental Component Summary (MCS) was 47.81, SD 10.71. Factors associated with depression, anxiety and poor QOL included having more than 5 ICD shocks (appropriate or inappropriate). Patients who felt that the ICD influenced their lifestyle positively, was 10.46 times more like to have mental well-being. This study showed that patients with ICDs managed in the state sector, is a vulnerable population. They often live far from hospital, have a high unemployment rate and a poor income. The HADS revealed that 21.4% of the patients had depressive symptoms and 28.6% fulfilled criteria for anxiety. The SF-36v2 revealed that the QOL of patients with ICDs was significantly lower than the norm, with regard to their physical and mental well-being. The study highlights the need for psychological and social support of patients living with ICDs. Keywords: quality of life; implantable cardioverter defibrillator; sudden cardiac death; arrhythmia; anxiety; depression; HADS; SF36v2. / Psychology / M.A. (Psychology)