Understanding implantable cardioverter defibrillator shocks and storms: medical and psychosocial considerations for research and clinical care.

The experience of shock is the distinguishing feature for patients with implantable cardioverter defibrillators (ICDs) and is associated with diminished psychological functioning and quality of life. Multiple shocks and ICD storm are a relatively common event among patients with ICDs (10-20%) and may present specific challenging medical and psychological management for the attending health care providers. This paper examines the medical and psychological aspects of ICD shocks and storms and describes a model of biopsychosocial management for patients following the experience of ICD storm. Successful management of patients post shock includes the use of antiarrhythmic medications and careful attention to the causality of the shocks via stored electrograms. The psychological management includes specific attention to debriefing post-shock feelings and attributions, preventing avoidance behavior, and facilitating positive "return to life" actions. Preliminary research examining formal psychosocial treatment supports a cognitive behavioral strategy to reduce psychological distress and facilitate quality of life. Collectively, these data suggest that interdisciplinary management of patients with multiple ICD shocks or the experience of ICD storm is advised, and routine psychological consultation may be indicated for the patient post ICD storm to reduce the possibility of symptoms of post-traumatic stress.