Ser cuidador informal de pacientes com doenças crônicas pode implicar em sobrecarga e sofrimento psicológico significativo, potencialmente prejudiciais para a própria saúde física e mental e para a recuperação do paciente. Pouco se sabe sobre as experiências e características psicossociais dos cuidadores de pacientes portadores de Cardioversor Desfibrilador Implantável (CDI), principalmente na população brasileira, de forma que o presente estudo (quantitativo descritivo transversal) teve por objetivos caracterizar demográfica e psicossocialmente uma amostra não probabilística de cuidadores informais de pacientes portadores de CDI que se encontravam em tratamento médico em um hospital-escola do interior do Estado de São Paulo. As variáveis estudadas incluíram: características sóciodemográficas, qualidade de vida, ansiedade, depressão e percepção de sobrecarga. Participaram da pesquisa 60 cuidadores, entrevistados entre setembro de 2010 a maio de 2011. Para a coleta dos dados foram usados: Roteiro de Entrevista Semiestruturada, elaborado para esta pesquisa, Questionário de Avaliação de Saúde SF-36, Escala Hospitalar de Ansiedade e Depressão e a Zarit Burden Interview. Os dados foram analisados quantitativamente de forma descritiva. Posteriormente verificou-se associação estatisticamente significativa (p<=0,05) entre algumas variáveis de interesse, por meio do Teste Exato de Fisher. Os resultados mostraram que a média de idade dos cuidadores foi de 52,5 anos (DP=14,76), eram em sua maior parte do sexo feminino (n=45, 75%), o cônjuge do(a) paciente (n=39, 65%), com escolaridade predominante de até quatro anos (n=28, 46,67%), sendo a maioria (45, 75%) portadora de problemas de saúde. Vinte e cinco cuidadores (41,67%) apresentaram sintomas indicativos de ansiedade e 13 (21,67%) de depressão. Na avaliação da qualidade de vida, a média de escore mais elevado foi no domínio Aspectos Sociais (Média=78,12, DP=27,48) e o mais baixo em Vitalidade (Média=60,25, DP=26,03). O escore médio relacionado à percepção de sobrecarga foi de 19,93 (DP=12,51, Mediana= 18,5). Os participantes relataram alterações significativas em suas vidas após o implante do CDI, preocupações com a saúde do paciente e funcionamento do dispositivo, dificuldades relacionadas ao papel de cuidador, além de dúvidas sobre o desfibrilador implantável. Os resultados confirmaram que o implante do CDI no paciente impactou significativamente na vida de seus cuidadores informais, sendo necessário o oferecimento de apoio emocional e orientações específicas por parte dos profissionais da saúde para auxiliá-los na adaptação e enfrentamento adequado dessas situações. Dada a escassez de estudos brasileiros nesta população e alguns fatores metodológicos limitantes, é necessário que mais investigações sejam realizadas para comparar estes resultados. / Being an informal caregiver of patients with chronic diseases may imply significant psychological burden and suffering, potentially harmful to caregiver\'s own physical and mental health and patient\'s recovery. Little is known about the psychosocial experiences and characteristics of caregivers of patients with Implantable Cardioverter Defibrillator (ICD), mainly in the Brazilian population, so that the purpose of the present study (transversal descriptive quantitative) was to characterize, both demographically and psychosocially, a nonprobabilistic sample of informal caregivers of patients with ICD undergoing treatment in a university hospital in the interior of the State of São Paulo. The studied variables comprised: sociodemographic characteristics, life quality, anxiety, depression and perception of burden. Sixty caregivers took part in the survey, and they were interviewed between September, 2010 and May, 2011. Data collection used the following instruments: Semi-structured Interview Script prepared for this survey, SF-36 Health Evaluation Questionnaire, Hospital Anxiety and Depression Scale and the Zarit Burden Interview. Data was analyzed quantitatively in a descriptive way. Subsequently, statistically significant association (p<=0,05) was verified between some variables of interest through Fisher\'s Exact Test. Results describe that the average age of caregivers was 52.5 years (DP=14.76), they were mostly female (n=45, 75%), and patient\'s spouses (n=39, 65%), predominantly with up to four years of education (n=28, 46.67%), and most (45, 75%) with health problems. Twenty-five caregivers (41.67%) presented symptoms related to anxiety and 13 (21.67%) to depression. In life quality evaluation, the highest average score was in the Social Aspects dominion (Average=78.12, DP=27.48) and the lowest in Vitality (Average=60.25, DP=26.03). The average score regarding burden perception was of 19.93 (DP=12.51, Median= 18.5). Participants reported significant changes in their lives after ICD implant, concerns about patient\'s health and device operation, difficulties concerning their role as caregivers, in addition to doubts about the implantable defibrillator. Results confirm that the ICD implant had a significant impact in the life of their informal caregivers, requiring provision of emotional support by healthcare professionals in order to help them adapt and properly cope with these situations. Due to the scarcity of Brazilian studies in this population and some limiting methodological factors, further investigation is required to compare these results.

Sammanfattning Implanterbar defibrillator (ICD) har visat sig förlänga överlevanden hos patienter med livshotande hjärtklappningar. Andelen bärare av implanterbara defibrillatorer förväntas att öka. Flera studier har redan beskrivit de drabbades livssituation och livskvalitet. Trots detta behövs det flera kvalitativa studier angående ICD-bärares erfarenheter i vardagen. Fenomenet att vara bärare av en implanterbar defibrillator beskrivs i föreliggande examensarbete utifrån en fenomenologisk forskningsansats och dess reflekterande livsvärldsperspektiv. Datainsamlingen utgjordes av nio djupintervjuer. Syftet var att beskriva innebörden av att vara bärare av en implanterbar defibrillator. Resultatet, fenomenets generella struktur, beskriver ett tvetydigt accepterande av en trygghet och otrygghet i livssituationen. Den aktiva och oförutsägbara kroppen är utsatt för något unikt, en tvetydig livlina. Fenomenets generella struktur belyses via fem konstituenter; det goda och onda tillslaget, känslan av stöd i omgivning, kunskap - en säkerhet i vardagen, den aktiva och oförutsägbara kroppen samt en utsatt kropp. Slutsatsen ses som ett accepterande av en tvetydig livlina. Att acceptera livlinan framkom i resultatet som ett självklart val. / Abstract Implantable Cardioverter Defibrillator (ICD) has shown to prolong survival in patients with life threatening tachyarrythmias. The number of implantable cardioverter defibrillators is expected to increase. Several studies have already described ICD-recipents life-situation and quality of life. However, additional qualitative studies concerning ICD-recipients everyday experiences are required. The phenomenon of living with an implantable cardioverter defibrillator is described in this paper from a phenomenological approach and its reflecting lifeworld perspective. The data collection was made out of nine in depth interviews. The purpose was to describe the meaning of living with an implantable cardioverter defibrillator. The result, the phenomenon’s general structure, describes an ambiguous acceptance of a security and insecurity in the life-situation. The active and unpredictable body is exposed to something unique, an ambiguous lifeline. The phenomenon’s general structure is highlighted through five constituents; the good and bad shock, the experience of support in those around, knowledge - a safety in the every day life, the active and unpredictable body and the exposed body. The conclusion is seen as an acceptance of an ambiguous lifeline. To accept the lifeline appeared from the result as the obvious choice.

Low levels of physical activity (PA) are a significant predictor of early death among recipients of implantable cardioverter defibrillators (ICDs). Regular, moderate PA is associated with improved quality of life (QOL), reduced arrhythmia burden, and improved health outcomes in ICD recipients yet many do not engage in PA and the reasons for lack of engagement are unclear. The purpose of this descriptive, cross-sectional study was to examine health beliefs related to PA and QOL in adults living with ICDs. The Health Belief Model provided the theoretical framework for this study. A convenience sample of 107 adult, ICD recipients (26 females and 81 males) were recruited from five cardiology clinic settings within the same private practice. Seventy-seven percent completed the study tasks (N=81). Subjects completed a Demographic Data Questionnaire, Self-Efficacy Expectations after ICD Scale, Exercise Self-Efficacy Scale, Health Belief Questionnaire, Incidental and Planned Exercise Questionnaire and Quality of Life Medical Outcomes Survey-SF36®. Clinical data was collected from the medical record. Mean age of the subjects was 70.23 yrs. ± 11.76 yrs. The majority were male (71.6 percent) and 77.8 percent were White, non-Hispanic. Most were insured by Medicare (79 percent), were retired (50 percent) and reported incomes less than 20,000 dollars/year (39 percent). Over 98 percent were diagnosed with heart failure and almost 40 percent reported their physical activity had decreased since having an ICD implanted. There were no differences in health beliefs and QOL scores between subjects who had an ICD as a primary or secondary prevention of sudden cardiac death. Predictors of PA participation in this population were Self-Efficacy for Exercise (SEE) beliefs, Self-Efficacy ICD (SEICD) beliefs, age and NYHA Class. Almost 33 percent of variance in PA participation can be explained by SEE (b = 2.407, β = .390, t = 3.911, p<.01); SEICD (b =2.304, β = .215, t = 2.149, p<.05); age (b = -.394, β = -.234, t =-2.277, p<.05); and NYHA Class (b = -6.373, β =-.198, t = -1.998, p =<.05). Findings indicate the strength of self-confidence in influencing healthy behavior. Findings support the need for more research in identifying barriers and predictors of PA participation in adult, ICD recipients.

Ser cuidador informal de pacientes com doenças crônicas pode implicar em sobrecarga e sofrimento psicológico significativo, potencialmente prejudiciais para a própria saúde física e mental e para a recuperação do paciente. Pouco se sabe sobre as experiências e características psicossociais dos cuidadores de pacientes portadores de Cardioversor Desfibrilador Implantável (CDI), principalmente na população brasileira, de forma que o presente estudo (quantitativo descritivo transversal) teve por objetivos caracterizar demográfica e psicossocialmente uma amostra não probabilística de cuidadores informais de pacientes portadores de CDI que se encontravam em tratamento médico em um hospital-escola do interior do Estado de São Paulo. As variáveis estudadas incluíram: características sóciodemográficas, qualidade de vida, ansiedade, depressão e percepção de sobrecarga. Participaram da pesquisa 60 cuidadores, entrevistados entre setembro de 2010 a maio de 2011. Para a coleta dos dados foram usados: Roteiro de Entrevista Semiestruturada, elaborado para esta pesquisa, Questionário de Avaliação de Saúde SF-36, Escala Hospitalar de Ansiedade e Depressão e a Zarit Burden Interview. Os dados foram analisados quantitativamente de forma descritiva. Posteriormente verificou-se associação estatisticamente significativa (p<=0,05) entre algumas variáveis de interesse, por meio do Teste Exato de Fisher. Os resultados mostraram que a média de idade dos cuidadores foi de 52,5 anos (DP=14,76), eram em sua maior parte do sexo feminino (n=45, 75%), o cônjuge do(a) paciente (n=39, 65%), com escolaridade predominante de até quatro anos (n=28, 46,67%), sendo a maioria (45, 75%) portadora de problemas de saúde. Vinte e cinco cuidadores (41,67%) apresentaram sintomas indicativos de ansiedade e 13 (21,67%) de depressão. Na avaliação da qualidade de vida, a média de escore mais elevado foi no domínio Aspectos Sociais (Média=78,12, DP=27,48) e o mais baixo em Vitalidade (Média=60,25, DP=26,03). O escore médio relacionado à percepção de sobrecarga foi de 19,93 (DP=12,51, Mediana= 18,5). Os participantes relataram alterações significativas em suas vidas após o implante do CDI, preocupações com a saúde do paciente e funcionamento do dispositivo, dificuldades relacionadas ao papel de cuidador, além de dúvidas sobre o desfibrilador implantável. Os resultados confirmaram que o implante do CDI no paciente impactou significativamente na vida de seus cuidadores informais, sendo necessário o oferecimento de apoio emocional e orientações específicas por parte dos profissionais da saúde para auxiliá-los na adaptação e enfrentamento adequado dessas situações. Dada a escassez de estudos brasileiros nesta população e alguns fatores metodológicos limitantes, é necessário que mais investigações sejam realizadas para comparar estes resultados. / Being an informal caregiver of patients with chronic diseases may imply significant psychological burden and suffering, potentially harmful to caregiver\'s own physical and mental health and patient\'s recovery. Little is known about the psychosocial experiences and characteristics of caregivers of patients with Implantable Cardioverter Defibrillator (ICD), mainly in the Brazilian population, so that the purpose of the present study (transversal descriptive quantitative) was to characterize, both demographically and psychosocially, a nonprobabilistic sample of informal caregivers of patients with ICD undergoing treatment in a university hospital in the interior of the State of São Paulo. The studied variables comprised: sociodemographic characteristics, life quality, anxiety, depression and perception of burden. Sixty caregivers took part in the survey, and they were interviewed between September, 2010 and May, 2011. Data collection used the following instruments: Semi-structured Interview Script prepared for this survey, SF-36 Health Evaluation Questionnaire, Hospital Anxiety and Depression Scale and the Zarit Burden Interview. Data was analyzed quantitatively in a descriptive way. Subsequently, statistically significant association (p<=0,05) was verified between some variables of interest through Fisher\'s Exact Test. Results describe that the average age of caregivers was 52.5 years (DP=14.76), they were mostly female (n=45, 75%), and patient\'s spouses (n=39, 65%), predominantly with up to four years of education (n=28, 46.67%), and most (45, 75%) with health problems. Twenty-five caregivers (41.67%) presented symptoms related to anxiety and 13 (21.67%) to depression. In life quality evaluation, the highest average score was in the Social Aspects dominion (Average=78.12, DP=27.48) and the lowest in Vitality (Average=60.25, DP=26.03). The average score regarding burden perception was of 19.93 (DP=12.51, Median= 18.5). Participants reported significant changes in their lives after ICD implant, concerns about patient\'s health and device operation, difficulties concerning their role as caregivers, in addition to doubts about the implantable defibrillator. Results confirm that the ICD implant had a significant impact in the life of their informal caregivers, requiring provision of emotional support by healthcare professionals in order to help them adapt and properly cope with these situations. Due to the scarcity of Brazilian studies in this population and some limiting methodological factors, further investigation is required to compare these results.

Purpose. To systematically develop and conduct preliminary evaluation of a decision support intervention to engage patients and their families about whether to accept or decline implantable cardioverter-defibrillator (ICD) pulse generator replacement. Methods. A series of studies using multi-methods and guided by the Ottawa Decision Support Framework and the Normalization Process Theory: 1) an integrative review of patients’ perspectives on ICD decision-making; 2) a systematic review of the risks and benefits of ICD replacement; 3) an embedded mixed methods study to iteratively develop a patient decision aid (PDA) and simultaneously plan for its implementation; and 4) a feasibility pilot randomized controlled trial to evaluate ease of recruitment, decision support intervention delivery and data collection. Findings. The integrative review of 25 articles reported that ICD decision-making was difficult and the majority of patients misunderstood ICD therapy. The systematic review of 17 nonrandomized studies reported that complication rates are higher at replacement as compared to initial implant, mortality benefit post ICD replacement is unclear, and patients’ clinical profile can affect ICD’s effectiveness. Findings from both studies were used to draft a PDA. Interviews with 18 end-users (clinicians, patients, spouses) revealed that the current ICD replacement process is automated and needs to elicit patient preferences. The PDA was considered the optimal tool to initiate the discussion of options. In a feasibility trial, 30 patients were randomized to the decision support intervention (PDA + decision coaching) (n=15) or usual care (n=15). The intervention was used as intended, users found the PDA acceptable but acceptability of decision coaching was variable. Patients exposed to the intervention had better knowledge scores compared to controls. Conclusion. The Ottawa Decision Support Framework and Normalization Process Theory were complementary frameworks to ensure that the decision support intervention has the potential for implementation. To determine whether this approach was successful, future research is required to evaluate and implement the intervention in clinical practice. Findings from the feasibility study will be used to design an effectiveness trial.

Polymorphic ventricular tachycardia (PVT) is a life-threatening arrhythmia that is typically related to long QT syndrome, organic heart disease, electrolyte abnormalities, cardiotoxic drugs, or adrenergic stimulation. A review of the literature reveals that PVT with normal QT interval and without underlying cause is quite rare. We report a case of idiopathic spontaneous PVT with structurally normal heart and without electrolyte abnormalities, drug reactions, or evidence of catecholamine induced arrhythmia. We also review the literature on the electrocardiographic characteristics and management of idiopathic PVT.

En del kardiovaskulära händelser kan leda till plötsligt hjärtstopp orsakat av en livshotande arytmi. Idag erbjuds dessa patienter en ICD som visat sig öka överlevnaden och ger patienten en möjlighet till ett fortsatt aktivt liv. Trots att ICD:n ger patienten goda förutsättningar att leva som vanligt finns en överhängande oro och rädsla som kan ge en negativ påverkan på livskvaliteten. Syftet var att undersöka vilka faktorer som påverkar livskvaliteten hos personer med ICD. En litteraturöversikt med systematisk metod användes där 17 artiklar inkluderades och analyserades med integrerad metod. Artiklarna hämtades från databaserna CINAHL och PubMed med hjälp av sökorden Implantable Cardioverter Defibrillator och Quality of Life. Endast kvantitativa artiklar publicerad mellan 2010-2020 inkluderades. I resultatet identifierades fem kategorier av faktorer som påverkar livskvalitet hos personer med en implanterbar defibrillator. Dessa var personrelaterade faktorer, terapirelaterade faktorer, vårdrelaterade faktorer, tidsrelaterade faktorer och devicerelaterade faktorer. Slutsatsen blev att livskvaliteten hos personer med en implanterbar defibrillator påverkas av många olika faktorer och att denna patientgrupp därför har mycket att vinna på att få personcentrerad vård. Exempelvis visade det sig att män och kvinnor kan gynnas olika mycket av interventioner såsom fysisk träning eller mentalt stöd där mäns livskvalitet verkar gynnas mer av fysisk träning medan kvinnors livskvalitet gynnas mer av mentalt stöd. Även ålder påverkade livskvaliteten hos denna patientgrupp där äldre ofta uppgav bättre livskvalitet än yngre personer. Dessa faktorer och dess påverkan på livskvaliteten hos personer med ICD bör studeras vidare i syfte att bättre förstå hur vården av denna patientgrupp kan personcentreras för att främja en god livskvalitet. / Some cardiovascular events can lead to sudden cardiac arrest caused by a life-threatening arrhythmia. Today these patients are offered an ICD that has been shown to increase survival and give the patient the opportunity for a continued active life. Despite the fact that the ICD gives the patient good conditions to live as usual, there is an imminent worry and fear that has a negative impact on the quality of life. The aim was to examine which factors affect quality of life in persons living with an ICD. A literature review with a systematic method was used where 17 articles were included and analyzed with an integrated method. The articles were retrieved from databases CINAHL and PubMed with the keywords Implantable Cardioverter Defibrillator and Quality of Life. Only quantitative articles published between 2010-2020 were included. Five categories of factors that affect quality of life in persons with an implantable cardioverter defibrillator were identified in the result. These were person related factors, therapy related factors, care related factors, time related factors and device related factors. In conclusion, quality of life in persons with an implantable cardioverter defibrillator is affected by several different factors, thus this patient group has a lot to gain from person centered care. For example, the results show that men and women can benefit in different amounts from interventions such as physical training or psychological support where quality of life in men seem to benefit more from physical training whereas quality of life in women seem to benefit more from psychological support. Age was another factor that affected quality of life in this patient group where older persons more often stated having a better quality of life than younger persons. These factors and their impact on quality of life in persons with an ICD should be studied further to better understand how care of this patient group can become more person centered in order to promote a good quality of life.

Long QT syndrome (LQTS) can present with syncope and seizure-like activity in the setting of torsades de pointes (TdP) with hemodynamic instability. Electrolyte abnormalities and medications can predispose to TdP in the setting of latent LQTS. An implantable cardioverter defibrillator (ICD) is needed if patients with TdP continue to be symptomatic despite medical treatment. We report a case of a patient who presented with seizures and was found to have prolonged corrected QT interval (QTc). During her admission, she was treated with ondansetron. She went into torsades de pointes and continued to have prolonged QTc. She underwent implantable cardioverter defibrillator (ICD) placement and remains asymptomatic to date.

It is a known problem that a Spinal Cord Stimulator (SCS) can interact with an Implantable Cardioverter Defibrillator (ICD) when both devices are implanted in the same patient. Interactions between the SCS and ICD can cause inappropriate therapy which can be harmful to the patient. While ICD devices have a distinct narrowband sensing bandwidth, the pulse configurations that current SCS devices deliver were not designed with this frequency region in mind. In this thesis, I recommend a new pulse configuration for SCS devices that will minimize the interaction between the two devices. I produce a theoretical equation for each pulse configuration in the frequency domain using the Laplace transform and present the results in Matlab. I also design my own SCS device to deliver multiple pulse configurations and use it to gather empirical data. The theoretical and empirical results are used to show the extent of the improvement between the new pulse and existing pulse configurations. The results prove that the new pulse configuration will significantly reduce crosstalk within the desired ICD bandwidth. A reduction in crosstalk will decrease the probability that an SCS will interact with a ICD device.

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