November 14, 2011

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By Matt McMillen

MONDAY, November 14, 2011 ( — Getting kicked in the chest by a horse—that's how cardiologist Steven Cook, MD, describes what it feels like when an implanted defibrillator shocks the heart.

And fear of that shock is making it difficult for many patients with these devices to enjoy sex, according to new research Dr. Cook presented today at a meeting of the American Heart Association (AHA).

It's a legitimate fear, since roughly one-quarter of patients with an implantable cardioverter defibrillator (ICD) will suffer from an inappropriate shock over a five-year period, says Dr. Cook, director of the center for adult congenital heart disease at Children's Hospital of Pittsburgh.

"When their heart rate shoots up to, say, 170, the device may not recognize that they are exercising or having vigorous sex," he says. "Instead, it may interpret it as an aberrant heart rate."

ICDs are small, battery-powered devices used to prevent dangerous heart-rhythm abnormalities (arrhythmias) in people with congenital heart disease, survivors of cardiac arrest, and others who are at risk. Unlike pacemakers, which provide only small pulses of electricity to keep the heart beating normally, ICDs can provide a powerful jolt when they detect a potentially life-threatening arrhythmia.

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To explore how the possibility of a shock might affect sex life, Dr. Cook and his colleagues surveyed 151 men and women with congenital heart disease, 41 of whom had an ICD. The participants, whose average age was 37, completed a series of questionnaires designed to assess their levels of anxiety and fear, sexual function and satisfaction, and depression.

Women had nearly the same level of sexual function regardless of whether they had an ICD. Men, on the other hand, tended to report mild erectile dysfunction if they had an ICD.

But the biggest differences in sexual satisfaction were between men and women who were anxious about the device firing during sex and those who were not. For both men and women, higher scores on the shock-anxiety questionnaire were associated with lower scores on the sexual-function measures.

Some patients do not cope well with ICD-related anxiety, Cook says. It's important to recognize those patients and refer them to a psychologist or other therapist who can address their fears and help the patients overcome them, he says.

"I can help them understand what's going on from a cardiologist's point of view, but maybe a psychologist can help them deal with the anxiety and get them back to having sex," Cook says. "I'm not here to give a bad buzz to devices at all. If they need to have a device to prevent sudden cardiac death, I want them to have that device. But I also want to provide excellent quality of life."

The 10-question shock-anxiety questionnaire used in the study—known as the Florida Shock Anxiety Scale—is "a really simple and quick test to determine who may need psychological counseling," Cook says. “We should be using it.”

Cook presented his research at the AHA's annual Scientific Sessions meeting in Orlando, Fla. Unlike the research published in medical journals, the study hasn't been thoroughly vetted by other experts in the field.

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