Post-traumatic stress disorder, emotional processing and inappropriate implantable cardioverter-defibrillator shocks: clinical consideration by a single case report

Introduction. Even though an overwhelming amount of evidence supports the clinical efficacy and safety of the implantable cardioverter defibrillator (ICD), inappropriate shocks for atrial arrhythmias with rapid ventricular conduction or for abnormal sensing results in multiple adverse effects Presentation. In this study we present the case of a 59- year-old woman who was admitted to hospital for ICD implantation with a past medical history that was positive for non-ischemic dilated cardiomyopathy, congestive heart failure (NYHA class III), atrial fibrillation, essential hypertension and a recent episode of syncope. Since in the 18 months follow-up the patient suffered many inappropriate shocks, we investigated the association of the presence of a PTSD (Post- Traumatic-Stress-Disorder) prior to implantation and a specific profile of cognitive processing emotions, with the effectiveness of the ICD. Emotional distress states and cognitive thoughts preceding ICD shock inappropriate episode were recorded by structured mobile diary (eMotional-ICDiary). We outlined how the presence of a highly traumatic event which had occurred 6 years previously was related to a recurrence of a combination of moderate distress and cognitive thoughts, associated with episodes of Inappropriate Shock. A psycho-diagnostic examination and the administration of the Emotional Processing Scale (EPS-25) and Emotional Regulation Questionnaire (ERQ) outlined that the patient presented a profile of cognitive processing of emotions characterized by elevated levels of unprocessed emotions, low appraisal and high suppression emotional regulation strategy. Conclusion. The observations gathered in this single case are a good starting point for further research in order to check if the post-traumatic stress disorder and a specific cognitive profile connected to the processing of emotions are associated with the presence of inappropriate ICD shocks. Further larger sample studies are required in this area.