No long-term psychological morbidity living with an implantable cardioverter defibrillator under advisory: the Medtronic Marquis experience

It is unclear whether there is important psychological morbidity associated with living with an implantable cardioverter defibrillator (ICD) under advisory and whether this should be factored into decision-making. Our study focused on patients living with advisory Medtronic Marquis ICDs. Patient adjustment to the ICD was evaluated using a validated device-specific metric of patient acceptance, the Florida Patient Acceptance Survey (FPAS). A comparison group of patients with other models of ICDs that were not under an advisory also completed the study measure. The questionnaire return rate was 86/122 (70.5%) in the advisory group and 94/134 (70.1%) in the non-advisory group. Only one patient in our clinic elected for generator change due to severe anxiety. There were no differences in demographic or clinical variables between the groups. There were no differences in the mean total FPAS score between the two patient groups (advisory patients 85.97 +/- 14.95 and 86.23 +/- 15.76 for non-advisory, P=0.340). Also there were no differences in any of the subscores. Correlates of poor device acceptance were younger age and a history of electrical storm. We found no evidence of increased long-term psychological morbidity in patients living with an ICD under advisory compared with patients with an ICD not under advisory. Our data suggest that patients and physicians should avoid hasty decisions about ICD replacement for psychological reasons.