Posttraumatic Stress Disorder after Delivering of Shocks by an Implantable Cardioverter-defibrillator

體內去顫器無預警電擊所引起的創傷後壓力疾患

陳弘偉(Hung-Wei Chen) ； 賴德仁(Te-Jen Lai) ； 張家銘(Chia-Ming Chang) ； William R. Bell

《台灣精神醫學》 19卷4期 (2005/12) Pp. 331-335

https://doi.org/10.29478/TJP.200512.0009

摘要

目的：惡性心室心率不整是成人猝死症原因之一，只有「植入性體內去顫器」(Implantable Cardiovascular Defibrillation，ICD)，才是唯一的保命符。本文報告一個因ICD電擊產生創傷後壓力疾患(Posttraumatic Stress Disorder，FTSD)的個案。個案報告：38歲男性，8年前曾因突發性心率不整而送急診電擊急救。由於近來心室心率不整發作多次，經醫學中心診斷為惡性心室心率不整，於一年前植入ICD。三個月後，個案於清醒下突發心率不整，瞬即ICD發出連續的電擊去顫來救命。之後雖未再發作，個案對被電擊的感覺，產生強烈的焦慮、憂鬱，及重複經驗、逃避、過度警覺的PTSD症狀。經抗憂鬱劑合併認知行為治療，症狀改善。結論：ICD所造成的電擊雖為救命，也可能造成個案的心理創傷，需要重視。

關鍵字

植入式體內去顫器 ； 創傷後壓力症候群 ； 焦慮

並列摘要

Objective: The implantable cardioverter defibrillator (ICD) is a device that continuously monitors the electrical activity of the heart and can terminate arrhythmias via defibrillation. We report a case of posttraumatic stress disorder (PTSD) after ICD shocks were delivered by the device due to an episode of arrhythmia. Case report: A 38 year-old man had suffered from sudden onset of cardiac arrest 8 years prior to this admission, when emergent resuscitation with defibrillation had saved his life. Due to the uncontrollable ventricular arrhythmia which began 7 years after the initial cardiac event and occurred repeatedly over 2 days, malignant ventricular arrhythmia was diagnosed and an ICD was implanted. Three months later, arrhythmia recurred and successive ICD shocks were delivered by the device with resulting stabilization. However, he developed serious anxiety, depression, and PTSD was diagnosed as a result of these events based on symptoms including re-experience, avoidance and hyperarousal. Antidepressants and cognitive behavior therapy were given and the symptoms improved. Conclusion: Awareness of the risk of PTSD in patients with an ICD after the delivery of shocks to correct arrhythmia is needed when using this device to treat patients with cardiovascular disease.

並列關鍵字

implantable cardioverter defribillator ； PTSD ； anxiety

參考文獻

Anonymous(1997).A comparison of antiarrhythmic thug therapy with implantable defibrillators in pa- dents resuscitated from near-fatal ventricular arrhythmias.N Engl J Med.337,1576-1583.

Wallace RL,Sears SF,Lewis TS,Oriffis JT,Curtis A,Conti JB(2002).Predictors of quality of life in long-term recipients of implantable cardioverter defibrillators.J Cardiopulm Rehabil.22,278-281.

May CD,Smith PR,Murdock CJ,Davis MJ(1995).The impact of the implantable cardioverter defibrillator on quality of life.Pacing Clin Electrophysiol.18,1411-1418.

Pauli P,Wiedemann G,Dengler W,Blaumann-Benninghoff G,Kuhlkamp V(1999).Anxiety in patients with an automatic implantable cardioverter defibrillator: what differentiates them from panic patients?.Psychosom Med.61,69-76.

Sears SF,Todaro JF,Lewis TS,Sotile W,Conti JB(1992).Examining the psychosocial impact of implantable cardioverter defibrillators: a literature review.Clin Cardiol.2,481-489.