Heart Rhythm: ICD放电对成人先天性心脏病患者性功能的影响

随着植入式心脏转复除颤器（ICD）的问世，越来越多的成人先天性心脏病患者植入ICD用于心源性猝死的一级或二级预防，其主要原因包括越来越多的恶性心律失常被发现及ICD技术的日益成熟。法洛氏四联症患者是需要植入ICD的最大亚群，既往的临床研究已经涉及了ICD植入失败及ICD相关并发症的原因分析，约30%-40%的患者存在ICD的不正确放电。

虽然ICD放电可以拯救患者的生命，但是其带来的心理上的影响也值得我们重视，植入ICD后焦虑及抑郁的发生率分别为13%-38%和9%-15%。植入ICD后心身障碍发生的主要原因包括担心ICD再次放电、对死亡的恐惧、社交障碍及性功能障碍。据此，Cook SC等进行了一项多中心的临床研究，旨在探讨ICD放电导致的焦虑与性功能障碍之间的关系。

该研究共入选180例先天性心脏病患者，其中植入ICD者70例，未植入ICD者110例，所有患者的平均年龄为32岁，根据先天性心脏病的复杂程度见患者分成轻中重度，其中轻度有32例，占18%；中度有93例，占52%；重度有54例，占30%。对于植入ICD的患者，其焦虑评分明显高于未植入ICD的患者，该研究采用的焦虑评分表为佛罗里达焦虑评分，绝大多数与ICD放电相关的焦虑患者存在性功能障碍，男性女性皆是如此，而且这些患者抑郁评分也明显高于未植入ICD的患者。

根据该项研究可得出以下结论：成人先天性心脏病患者植入ICD后有相当比例的患者存在焦虑，这些患者的焦虑与心功能障碍呈明显相关性。因此我们必须对ICD植入患者的性功能引起足够的重视。

Shock-related anxiety and sexual function in adults with congenital heart disease and implantable cardioverter-defibrillators.
BACKGROUND
An increasing number of adults with congenital heart disease (CHD) require implantable cardioverter-defibrillators (ICDs), yet little is known about their impact on psychological well-being and sexual function.
OBJECTIVE
To assess shock-related anxiety in adults with CHD and its association with depression and sexual function.
METHODS
A prospective, multicenter, cross-sectional study was conducted on adult patients with CHD with (ICD+) and without (ICD-) ICDs. The Florida Shock Anxiety Scale was administered to patients with ICD+ and the Beck Depression Inventory-II to all patients. Men completed the Sexual Health Inventory for Men, and women completed the Female Sexual Function Index.
RESULTS
A total of 180 adults with CHD (ICD+: n = 70; ICD-: n = 110; median age 32 years [interquartile range 27-40 years]; 44% women) were enrolled. The complexity of CHD was classified as mild in 32 (18%), moderate in 93 (52%), and severe in 54 (30%) subjects. In ICD recipients, a high level of shock-related anxiety was identified (Florida Shock Anxiety Scale score 16; interquartile range 12-23.5), which was slightly higher than the median score for ICD recipients in the general population (P = .057). A higher level of shock-related anxiety was associated with poorer sexual function scores in both men (Spearman's ρ =-.480; P<.001) and women (Spearman's ρ =-.512; P<.01). It was also associated with self-reported depressive symptomatology (Spearman's ρ = .536; P< .001).
CONCLUSIONS
Adults with CHD and ICDs demonstrate a high level of shock-related anxiety, which is associated with lower sexual functioning scores in men and women. These results underscore the need for increased clinical attention related to ICD-related shock anxiety and impaired sexual function in this population.