Implantable Cardioverter-Defibrillator (ICD) Linked to Lower Sexual Function Scores

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Using the Sexual Health Inventory for Men scale, research, presented at the American Heart Association, suggests that men with congenital heart disease and an ICD had lower sexual function scores than men with congenital disease but no ICD.

An implantable cardioverter-defibrillator (ICD) is a device used to detect cardiac arrhythmia (sudden failure of the heart to beat) and to reverse it by producing a jolt of electricity. It is a small battery-powered electrical impulse generator which is implanted in patients who are at risk of sudden cardiac death due to ventricular fibrillation (sudden uncoordinated cardiac contraction) and ventricular tachycardia (fast-beating of the heart that originates from one of the ventricles). ICD is a pre-programmed device implanted in the patient.

However, there was no difference, in scores for women with and without ICDs when assessed with the Female Sexual Function Index, Stephen C. Cook, MD, from Children’s Hospital of Pittsburgh, and colleagues reported. “Studies have shown that many adults with congenital heart disease still have inappropriate shocks up to five years post-implantation,” Cook told MedPage Today during an interview. “In general, the five-year freedom from inappropriate shock is about 74%.” An educational material and guidelines for resuming sexual activity after being fitted with an ICD are “conflicting or unavailable” according to him. Physicians often don’t broach the topic of sexual function in this patient population and “if they don’t ask, they won’t know,” Cook added.”Treatment planning should be guided to address specific worries,” he said. “We should perhaps develop a ‘shock plan’ rather than disseminate information about battery life.”

Evaluating psychological interventions aimed at reducing distress during sexual activity, Cook and colleagues recruited 150 congenital heart disease patients from four centers: 110 did not have ICDs (49% women), while 40 had them (41% women). The median age of those without and with ICDs was 32 and 37, respectively. The Florida Shock Anxiety Scale, which examines triggers and consequences, was used as a tool by the researchers. Triggers are things such as exercise, running, or sex that increase heart rate and can set off the device. Consequences are fears of the device going off in a public place, for example, or during sex. Also, Beck Depression Inventory Scale-II was used to evaluate severity and existence of depression. Later on, it was then unleashed that men with devices had lower scores on the sexual function test, which is indicative of anxiety and erectile dysfunction (19.3 versus 21.7, P=0.09).

The findings with previous data of older patients with ICDs but no congenital heart disease, so-called normative patients were also served as basis of comparison. They found that the younger patients with congenital heart disease in this study scored higher on their consequences and triggers scale than the normative patients (6.3 versus 1.54 for consequences and 4.6 versus 1.55 for triggers). “I would have thought the reverse would be true,” Cook told MedPage Today. “The older cohort in the original Florida Shock Anxiety Scale test only had their devices three months on average, whereas some of our cohort of congenital patients had their devices up to a year, plenty of time to get used to them.”

For the coming years, Cook intended to propose the Florida Shock Anxiety Scale to be introduced by physicians or nurses in the pre-implant stage to assess any anxiety problems of patients.

 

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