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ICD testing after implantation linked to impaired cognitive function
5 March 2010
MedWire News: Over a third of patients have significant psychological functioning impairments in the year after undergoing implantable cardioverter defibrillator (ICD) surgery related to ventricular defibrillation testing (VDT) of the device, researchers report.
Cognitive problems were seen at 6 weeks and 6 and 12 months after ICD surgery and frequently included impairments in attention, short-term auditory memory, and visual recall.
“What’s surprising is that this minor procedure, which has very short periods of ventricular defibrillation induction, results in significant decline in multiple areas of cognitive function,” commented lead author Claire Hallas (Sultan Qaboos University, Oman).
Although most patients regained their normal neuropsychologic functioning level at 12 months, a small proportion of patients started to develop problems at this later stage.
Increased cerebral ischemia and a reduction in blood pressure occur during the VDT procedure, but so far the potential acute and or/long term neuropsychological effects of VDT and ICD implantation have not been explored in depth, explain the researchers in the journal Circulation: Arrhythmia and Electrophysiology.
To investigate further, Hallas and colleagues studied 52 ICD recipients who completed validated neuropsychological tests 1–3 days before ICD surgery and then 6 weeks, 6 months, and 12 months after the surgery.
Results showed that the incidence of cognitive impairment appeared consistent at over 30% of participants at each follow-up. However, the incidence varied among participants over time. Of 17 patients with impairments at 12 months, only five (10% of total sample) had impairments at 6 weeks. Meanwhile seven patients showed temporary impairment at 6 weeks, and for 12 participants impairment developed at 6 months (19%) or 12 months (7%).
Neuropsychological impairment was not related to mood or quality of life at follow-up, although anxiety and depression predicted reduced quality of life.
“Doctors need to be aware of screening patients early on for particular problems and then referring patients for psychological testing if they have concerns about effects that are more consistent over 2 or 3 months,” said Hallas.
