Device therapy (pacemakers and implantable cardioverter defibrillators [ICD]) has been a part of our armamentarium for treating rhythm disorders for many years. However, the number of devices being implanted has been on the rise, such that the number of patients living with devices increased by nearly 50% during the 1990s, and this number is expected to further increase. Numerous studies in recent years have resulted in expanding indications for device implantation, including biventricular pacemakers for heart failure patients with intraventricular conduction disorders and ICDs for patients with cardiomyopathy (ischemic and nonischemic). The resultant expected growth in device implants will increase the likelihood that nurses, regardless of practice area, will encounter a patient with a pacemaker or ICD. Cardiovascular nurses should have a fundamental understanding of indications for both pacemaker and ICD implant, be able to recognize common device-related problems, understand ICD therapy, and be aware of the effect of device implantation on the psychological well-being of the patient.
This issue of the Journal of Cardiovascular Nursing (JCN) includes a series of articles examining unique issues for a subset of cardiac patients whose therapeutic regimen includes implantation of a rhythm device. The objective of this series is to provide cardiovascular nurses with a foundation of general pacemaker information as well as to explore more specific areas of interest: a potential procedural complication, ICD therapy and new indications for ICD implant, and a discussion of psychological implications for patients with ICDs. We intended this series to elucidate in broad strokes several issues that may have an impact on patients with cardiac and rhythm issues. It is beyond the scope of this article to attend to the breadth of specific information related to programming and advanced troubleshooting of these devices.
An overview of basic and advanced pacemaker information begins the series. Jennifer Woodruff, a nurse who specializes in caring for patients with devices, provides a comprehensive review of current pacemaker indications, including biventricular pacemaker implantation, potential complications, and troubleshooting common pacemaker problems. Special management issues for patients with device implants are addressed as well. As much of the information in this article is relevant to both pacemakers and ICDs, it serves as an excellent foundation for cardiovascular nurses caring for patients with devices.
Christine Howell, an acute care nurse practitioner working with heart failure patients, examines the research findings regarding the purported benefits and challenges of cardiac resynchronization therapy. In the case study portion of her article, Ms Howell describes an unusual complication following implantation of a biventricular pacemaker. While any device implantation may result in an untoward complication, biventricular device implantation has particular implications of which clinicians should be aware.
In the third article of our series, Melanie Gura, a clinical nurse specialist who directs an arrhythmia consultation service, critically examines recent ICD studies and their impact on implantation guidelines. Ms Gura affords us the benefit of her specialized knowledge as she discusses ICDs as secondary prevention as well as the application of ICDs as primary prevention therapy for patients with ischemic and nonischemic cardiomyopathy. In addition, she reviews specifics about ICD detection of arrhythmias, therapy, and follow-up management.
Finally, the series takes a step back from the mechanics and the physiologic impact of device intervention and explores the potential psychological ramifications for patients living with an ICD. A review of current literature indicates that patients with ICDs have higher levels of anxiety and depression compared to the average level in the general population. In this last article of the series, I describe an unusual psychological manifestation, called phantom shock, observed in some patients with ICDs and discuss the potential contribution of anxiety, depression, and adjustment issues on its development. The article also discusses implications for nursing practice and suggests practical strategies to attend to the psychological needs of patients with ICDs.
It is our hope that the series will provide an overview and solid foundation of information that will inform the care the clinician provides to patients with devices.
Liza Prudente, MSN, RN, ACNP
Series guest editor