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  • br Material and methods br Results br Discussion PV isolatio


    Material and methods
    Discussion PV isolation is currently the cornerstone for treatment of patients with paroxysmal AF [6]. An extended technique is circumferential PV isolation using point-by-point ablation around the PV ostium. However, that is a technically challenging and time-consuming procedure. In order to overcome the inherent limitations of conventional PV isolation ablation, new technologies have been developed with the main objective of simplifying and shortening the procedure itself.
    Conflict of interest
    Introduction The implantable cardioverter-defibrillator (ICD) is well-established as the superior choice compared to anti-arrhythmic drugs for the prevention of sudden cardiac death (SCD) [1,2]. The use of ICDs has been expanded to certain patient populations who have either survived an episode of life-threatening ventricular arrhythmia (secondary prevention) or who are at risk for ventricular arrhythmia (primary prevention) [2]. Although acceptance of the device is generally high among patients and their families, quality of life (QOL) and psychosocial issues associated with use of an ICD deserve greater attention [3]. Anxiety, depression, anger, and fear are the most common psychosocial responses after ICD tie2 [3,4]. Nearly half of the patients with an ICD have depression and anxiety [5]. SCD occurs in approximately 40 cases per every 100,000 persons annually in each country of Asia [6]. A previous study showed that during a 5-year period, the Japan Cardiac Device Therapy Registry demonstrated a significant increase in the utilization of prophylactic ICDs [7]. Paradoxically, limited data exist regarding the effect of ICD indications on QOL and psychological distress in Japanese patients. A previous study suggested that there was no evidence to suggest that patients receiving an ICD for primary prophylaxis had a subsequently poorer QOL and greater distress than patients receiving an ICD for secondary prophylaxis [8]. However, patients identified to receive an ICD for primary prophylaxis differ from patients who receive the device for secondary prevention. In particular, primary prophylaxis patients may fail to understand why carpels need the device. In relation to health-related QOL, one study found that the QOL did not significantly differ between primary and secondary prevention ICD recipients [9]. Another study showed no differences in mean depression and mean anxiety scores between primary and secondary prevention ICD patients [5].
    Materials and methods
    Discussion Our study demonstrated higher trait anxiety and increased worries about an ICD in ICD patients with a primary prevention indication. In contrast, Bilge et al. did not find any differences in anxiety in primary and secondary prevention indication subgroups [5]. Possible reasons for this discrepancy are the type of questionnaire and smaller sample size of the previous study. However, both this study and the study by Bilge et al. found no differences in depression between the two ICD indication groups. According to the previous study, exposure to shocks may lead to an increased risk of anxiety [26]. In this study we did not find an independent association between shocks and anxiety. However, the patients with a primary prevention ICD experienced more shocks compared to patients with a secondary prevention indication. A study by Groeneveld et al. also showed that patients receiving a ICD for secondary prevention had more shocks compared with a primary indication, and shocks were associated with a lower QOL in primary prevention patients [9]. One possible explanation is that secondary prevention patients, by definition, experienced a prior cardiac arrest or ventricular arrhythmia. Therefore, secondary prevention patients may have assessed their risk of SCD as being higher, and thus found their ICDs to be potentially lifesaving (particularly if the devices had actually delivered a shock). Besides the primary prevention indication, being female also showed an association with worries about an ICD; this is consistent with our previous study [10]. Above all, behavioral interventions have shown promise with respect to reducing distress such as anxiety and worries in ICD patients [27].