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Anxiety and depression in inherited channelopathy patients with implantable cardioverter-defibrillators
Open accessAbstract
Background Implantable cardioverter-defibrillators (ICDs) are an effective treatment in some patients with inherited heart disease, including inherited channelopathies, yet they have also been shown to impact patients' psychological health. Objective We sought to improve understanding of the level of anxiety and depression as well as device acceptance among inherited channelopathy patients with an ICD. Methods Eligible patients seen at Johns Hopkins Hospital were sent a survey, which included the Hospital Anxiety and Depression Scale (HADS), Cardiac Anxiety Questionnaire (CAQ), and the Florida Patient Acceptance Survey (FPAS). Student t tests and χ 2 tests were used to identify associations with abnormal anxiety and depression scores. Results Among eligible patients (n = 65), 32 individuals (49%) completed the survey. The rate of device-related complications was 34%, and 41% of patients experienced 1 or more ICD shocks. Twelve patients (38%) had an abnormal HADS anxiety subscore and 5 patients (16%) had an abnormal HADS depression subscore (score ≥ 8). Secondary-prevention ICDs were associated with an abnormal HADS anxiety subscore ( P = .03). Experiencing ICD shock(s), device complications, age, sex, and family history of sudden cardiac death were not statistically associated with anxiety or depression. Overall, respondents demonstrated high device acceptance by FPAS (79.9 ± 2.9, maximum total score 100) and moderately high cardiac-specific anxiety by CAQ total score (1.53 ± 0.12). Conclusion A high prevalence of generalized anxiety was identified among inherited channelopathy patients with ICDs. High device acceptance and lack of association with ICD shocks or complications indicate that further research is necessary to understand this increased incidence.
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Environmental modifiers such as endurance exercise, psychological stress, diet, alcohol, and metabolic dysregulation influence ACM disease penetrance and progression, in part through modulation of inflammatory processes.
“environmental modifiers such as endurance exercise [24,25,26,27,28,29,30], psychological stress [31,32,33], diet [34,35], alcohol [36], and metabolic dysregulation [37,38,39] have been shown to influence disease penetrance and progression, in part, through modulation of inflammatory processes.”
From A Paradigm Shift: Arrhythmogenic Cardiomyopathy Is an Inflammatory Disease (2026) · cites this paper as [33]
The Discussion reports anxiety and depression in patients with inherited channelopathies and ICDs, but does not link psychological stress to ACM penetrance or progression. Searches for stress, inflammatory processes, and the other listed modifiers found no passage addressing the claimed mechanism. (LLM, conf=0.76)
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Lichtman, J. H., Froelicher, E. S., Blumenthal, J. A., Carney, R. M., Doering, L. V., Frasure-Smith, N., Freedland, K. E., Jaffe, A. S., Leifheit-Limson, E. C., Sheps, D. S., et al. (2014) · Circulation · doi:10.1161/cir.0000000000000019 · Cited by 1,208
The Cardiac Anxiety Questionnaire: development and preliminary validity
Eifert, G. H., Thompson, R. N., Zvolensky, M. J., Edwards, K., Frazer, N. L., Haddad, J. W., & Davig, J. (2000) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(99)00132-1 · Cited by 349 · cited 1×
“The Cardiac Anxiety Questionnaire (CAQ) is an 18-item 5-point Likert scale survey divided into subscores for fear, avoidance, and heart-focused attention, which are reported from 0 to 4, with higher scores indicating worse anxiety.(14) The Florida Patient Acceptance Survey (FPAS) is an 18-item 5-point Likert scale sur…”
BackgroundPsychological treatment of cardiac patients: a meta-analysis
Linden, W., Phillips, M. J., & Leclerc, J. (2007) · European Heart Journal · doi:10.1093/eurheartj/ehm504 · Cited by 284
Magyar-Russell, G., Thombs, B. D., Cai, J. X., Baveja, T., Kuhl, E. A., Singh, P. P., Montenegro Braga Barroso, M., Arthurs, E., Roseman, M., Amin, N., et al. (2011) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2011.02.014 · Cited by 267
Cardiac anxiety after sudden cardiac arrest: Severity, predictors and clinical implications
Rosman, L., Whited, A., Lampert, R., Mosesso, V. N., Lawless, C., & Sears, S. F. (2015) · International Journal of Cardiology · doi:10.1016/j.ijcard.2014.11.115 · Cited by 52 · cited 1×
“We compared our results to 3 other reports of CAQ scores: an HCM/long QT syndrome cohort, a cohort of cardiology patients with ICDs, and a cohort of sudden cardiac arrest survivors, which included patients with ICDs, long QT syndrome, and HCM (Figure 2).(21,24,25) Our cohort had a similar pattern and level of cardiac…”
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Research works printed but not linked: 20
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A Paradigm Shift: Arrhythmogenic Cardiomyopathy Is an Inflammatory Disease
Ariyaratne, G. H. D. N., Villatore, A., Peretto, G., & Chelko, S. P. (2026) · Cells · doi:10.3390/cells15100868 · Cited by 2
Metadata
- Authors
- Singh, S. M., Murray, B., Tichnell, C., McClellan, R., James, C. A., & Barth, A. S.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Singh, Sajya M.
- ORCID
- Venue
- Heart Rhythm O2
- Publisher
- Elsevier BV
- Published
- 2021-08
- Volume
- 2
- Issue
- 4
- Pages
- 388-393
- ISSN
- 2666-5018 (ISSN-L)
- PMC
- PMC8369306
- OpenAlex
- W3170639904
- Cited by
- 18
- References
- 5
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 3 · 2023: 7 · 2022: 2
- FWCI
- 2.01
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Heart Rhythm O2 (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Boston Scientific Corporation
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- implantable cardioverter-defibrillator, inherited channelopathies, anxiety, depression, device acceptance, ICD shocks, device complications, secondary prevention, sudden cardiac death, mental health, cardiac anxiety
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