Treatment of phantom shocks: A case report

Understanding Phantom Shocks in Implantable Cardioverter-Defibrillator Recipients

Phantom shocks in implantable cardioverter-defibrillator (ICD) recipients create a complex nexus between cardiac treatment and psychological distress. These sensations, mimicking therapeutic shocks without device activation, deeply affect patients' functionality and well-being. Heightened anxiety, depression, and hopelessness predispose individuals to these occurrences, posing significant challenges. This article delves into the intricate nature of phantom shocks, highlighting subtle clinical cues to differentiate them from genuine therapy shocks. Through a case study of a 75-year-old male with recurrent ICD shocks, diagnosed eventually with phantom shocks, the interplay between psychological distress and physical sensations is underscored. Urgent intervention to address the patient's anxiety and depression using psychotherapy and antidepressants became imperative. The case underscores the immense psychological toll of phantom shocks, exacerbating fear, hopelessness, and post-traumatic stress disorder (PTSD). Despite treatment attempts, their impact persisted, leading to a shift to comfort-focused care. While research identifies factors such as education levels and prior therapy, predicting and managing phantom shocks remains challenging. This article stresses the need for clinician vigilance, urging proactive identification and tailored interventions to mitigate the profound effects of phantom shocks. The current research landscape lacks comprehensive strategies, necessitating further exploration and targeted therapies to restore patient well-being. In conclusion, comprehensive understanding and specialized care for phantom shocks in ICD recipients, addressing both cardiac and psychological aspects, are imperative. Early recognition and tailored interventions offer promise in alleviating their adverse effects, reinstating patient control, and improving their quality of life.

Phantom Shocks Associated With a Wearable Cardioverter Defibrillator

Wearable cardioverter defibrillators (WCDs) are external devices capable of continuous cardiac rhythm monitoring as well as automatic detection and defibrillation of potentially life-threatening arrhythmias such as ventricular tachycardia (VT) and ventricular fibrillation (VF). They are an alternative approach for patients when an implantable cardioverter defibrillator (ICD) is not appropriate. Although treatment with ICD is considered highly effective for the primary and secondary prevention of sudden cardiac death (SCD) in high-risk patients susceptible to VT and VF, patients may still experience psychological difficulties such as fear of shock, avoidance of normal behaviors and reduced quality of life. One of these phenomena is phantom shock (PS), which is defined as a perception of having received a shock with no evidence of recorded defibrillation upon device interrogation. While PS has been reported in the ICD literature, to the best of our knowledge, we present the first known case of WCD-related PS. We also present a review of the current literature to explore the prevalence of PS, the factors associated with its pathogenesis and interventional studies aimed at reducing its occurrence. We highlight this case because PS is considered a phenomenon that few recognize, which should be discriminated from real device shocks before clinicians initiate treatment, device reprogramming or device discontinuation. We describe the psychosocial factors associated with PS to emphasize the importance of managing any associated psychiatric disorders and psychosocial factors both before and after initiation of device treatment.