Fears about ICD shock during sex leads to performance problems in heart patients

Adults with congenital heart disease and implanted cardioverter defibrillators (ICDs) often have a high level of fear and anxiety about the device delivering a shock during sex - resulting in sexual performance problems, according to research (Abstract 14165) presented at the American Heart Association's Scientific Sessions 2011.

An ICD is an implanted, battery-powered device that monitors the heartbeat. If the ICD detects a dangerous irregular heartbeat, it delivers a shock to restore normal rhythm. The shock can be painful and some patients say it feels like a kick in the chest.

Among the 151 study participants, 41 had an ICD. The average age was 37 for those with an ICD and 32 for those without. Women comprised 41 percent of those with an ICD and 49 percent of those without the device.

In the survey, participants rated their sexual function, level of depression and, for those with ICDs, their level of fear and anxiety about experiencing an ICD shock.

The men's sexual function survey included questions about confidence, satisfaction and the ability to maintain an erection during sex. The women's questionnaire rated interest, arousal, satisfaction and pain during sex.

Overall, men with ICDs scored an average sexual function score of 19, which is consistent with mild erectile dysfunction, while scores of men without ICDs demonstrated normal sexual function. Women with and without ICDs had similar sexual function scores - 65 and 67, respectively. However, men and women with ICDs who had a high level of fear about getting shocked - called shock-related anxiety - had lower sexual function scores.

Depression scores were the same for those with and without an ICD and were in normal range.

The results of this study suggest that patients and doctors should talk about these concerns to help patients cope with the increased anxiety surrounding the ICD and refer them for appropriate counseling when indicated, said Stephen C. Cook, M.D., lead researcher of the Shock-ICD study and director of the Adult Congenital Heart Disease Center at Children's Hospital of Pittsburgh of UPMC.

"Communication among healthcare providers and patients is essential," Cook said. "Patients require counseling both before and after device placement particularly if they continue to report high levels of nervous feelings. "

Co-authors are Paul Khairy, M.D.; Doug Landsittel, Ph.D.; Mary Amanda Dew, Ph.D.; Curt J. Daniels, M.D.; Jenne Hickey, N.P; Jennifer Burger, Psy.D.; Amy Harmon, B.A.; Mathieu Clair, M.D.; Frank Cecchin, M.D.; Gregory R. Webster, M.D. and Anne Marie Valente, M.D.

• In an unrelated study (abstract 10800), significant others' physical health worsened while their mental health improved after one year of caring for someone with an ICD.
• None of the patients had congenital heart disease.
• Average age of the significant others was 60, 97 percent were Caucasian and 84 percent were female.
• For the 127 significant others who participated in the analysis, the most difficult time - physically and mentally - was the first three months after the ICD implantation.
• The psychological demands and adjustment were most challenging for the caregivers immediately after the patients left the hospital, researchers said.

Early symptoms among caregivers included high anxiety, depression and increased physical symptoms, said Cynthia M. Dougherty, R.N., Ph.D., the study's lead researcher and professor at the University of Washington School of Nursing in Seattle.

Researchers recommend interventions to help caregivers during the first three months.