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(144) Case Report: Determining Capacity to Electively Deactivate an Automatic Implanted Cardioverter-defibrillator in a Patient with a History of Depression


Authors:

Shamik Mukherji, MD – Consultation Liaison Psychiatrist, Long Island Jewish Medical Center Northwell Health


Co-Authors:

Presenting Author: Shamik Mukherji, MD, Long Island Jewish Medical Center - Northwell Health

Abstract:

An Automatic Implanted Cardioverter-Defibrillator (AICD) is a life saving device for indications such as severe left ventricular dysfunction or ventricular tachyarrhythmias 1. The placement of AICD’s is associated with increased rates of shock related anxiety, post-traumatic stress, depression, and lower health-related quality of life 2,3,4. We present a case in which a 52 year old male with a history of depression and severe left ventricular dysfunction presents to the hospital with a request that his AICD be deactivated. This patient received 8 defibrillations from the AICD in the 2 weeks prior to admission, all of which were determined to be appropriate shocks. Psychiatry was consulted to determine the degree to which the patient’s depression may be contributing to his decision, and to determine the patient’s medical decision-making capacity to deactivate his AICD. Following Applebaum’s criteria for medical capacity assessment, the patient was able to express clear and consistent choice, a high degree of understanding and appreciation of the relevant parameters of this choice, and good reasoning with good contingency planning 5. He thus demonstrated capacity to make the decision to deactivate his AICD. The patient’s decision was indeed informed by shock-related anxiety, with a final determination that the patient’s quality of life was negatively affected by continued activation of the AICD. After medical capacity assessment, deactivation was performed. This case highlights the degree to which the psychological and psychiatric implications of AICD placement should be considered when determining if a patient is a good candidate for such a device.


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    1. Hamner M, Hunt N, Gee J, Garrell R, Monroe R. PTSD and automatic implantable cardioverter defibrillators. Psychosomatics. 1999 Jan-Feb;40(1):82-5.

 


    1. Habibović M, Denollet J, Pedersen SS; on behalf of the WEBCARE investigators. Posttraumatic stress and anxiety in patients with an implantable cardioverter defibrillator: Trajectories and vulnerability factors. Pacing Clin Electrophysiol. 2017 Jul;40(7):817-823.

 


    1. Perini AP, Kutyifa V, Veazie P, Daubert JP, Schuger C, Zareba W, McNitt S, Rosero S, Tompkins C, Padeletti L, Moss AJ. Effects of implantable cardioverter/defibrillator shock and antitachycardia pacing on anxiety and quality of life: A MADIT-RIT substudy. Am Heart J. 2017 Jul;189:75-84.

 


    1. Appelbaum PS. Clinical practice. Assessment of patients' competence to consent to treatment. N Engl J Med. 2007 Nov 1;357(18):1834-40. Review.


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