PSYCHIATRIC COMORBIDITIES IN PATIENTS WITH CARDIAC PACEMAKERS: A NARRATIVE REVIEW
DOI:
https://doi.org/10.71000/2r75zz57Keywords:
Cardiac Pacemakers, Anxiety, Depression, PTSD, Psychological Comorbidities, Narrative ReviewAbstract
Background: Cardiac pacemakers are widely used to manage bradyarrhythmias and conduction disorders, significantly improving survival and quality of life. However, the psychological impact of pacemaker implantation remains an underexplored area in cardiology. Anxiety, depression, and posttraumatic stress disorder (PTSD) are increasingly recognized in pacemaker recipients, often affecting their emotional well-being, adherence to treatment, and long-term prognosis.
Objective: This narrative review aims to explore the prevalence, presentation, and contributing factors of psychiatric comorbidities—particularly anxiety, depression, and PTSD—among patients with cardiac pacemakers and to evaluate current evidence regarding their identification and management.
Main Discussion Points: Recent studies reveal that a notable proportion of pacemaker patients experience clinically significant psychological symptoms, influenced by individual factors such as age, prior mental health history, illness perception, and body image concerns. Psychological distress is often subclinical but can persist and negatively impact recovery. Evidence suggests that cognitive-behavioral therapy and psychoeducational interventions can effectively reduce symptoms, although large-scale randomized controlled trials are lacking. Major limitations in current literature include small sample sizes, cross-sectional designs, lack of standardized outcome measures, and limited long-term data.
Conclusion: Psychiatric comorbidities in pacemaker recipients represent a clinically significant yet frequently overlooked issue. Integrating psychological screening and interventions into routine cardiac care is recommended to support comprehensive patient management. Further longitudinal and interventional studies are needed to strengthen the evidence base and guide effective clinical strategies.
References
Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, et al. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J. 2021;42(35):3427-520.
Maurhofer J, Asatryan B, Haeberlin A, Noti F, Roten L, Seiler J, et al. Acute and long-term outcomes of quadripolar IS-4 versus bipolar IS-1 left ventricular leads in cardiac resynchronization therapy: A retrospective registry study. Pacing Clin Electrophysiol. 2023;46(5):365-75.
Orlando F, Giuffrida S, Vicari R, Sansalone A, Dell'Avo A, Bernasconi S, et al. Adverse clinical events during the first 24 h of bedrest following cardiac electronic device implantation: a prospective observational study. Eur J Cardiovasc Nurs. 2023;22(2):175-83.
Senior J, Kuehl M. Cardiac implantable electronic device malfunction due to twiddler's syndrome in a patient with bipolar affective disorder. BMJ Case Rep. 2021;14(10).
Iskenderov B, Гусейнович ИБ, Petrova E, Владимировна ПЕ, Maksimov D, Борисович МД, et al. [Comorbid anxiety disorders and quality of life in patients with an artificial cardiac pacemaker]. Terapevticheskii arkhiv. 2011;83 10:54-8.
Long V, Guertin M, Dyrda K, Benrimoh D, Brouillette J. Descriptive Study of Anxiety and Posttraumatic Stress Disorders in Cardiovascular Disease Patients: From Referral to Cardiopsychiatric Diagnoses. Psychotherapy and Psychosomatics. 2018;87:370-1.
Knops RE, Reddy VY, Ip JE, Doshi R, Exner DV, Defaye P, et al. A Dual-Chamber Leadless Pacemaker. N Engl J Med. 2023;388(25):2360-70.
Dang L, Kroenke K, Stump T, Monahan P, Connors J, Cherynak Y, et al. Elevated Psychiatric Comorbidities in Patients with Low-risk Chest Pain Presenting in The Emergency Department. Proceedings of IMPRS. 2024.
Wang X, Ke Y, Cao Z, Fu Y, Cheng Y, Liu D, et al. Exosomes activate hippocampal microglia in atrial fibrillation through long-distance heart-brain communication. BMC Cardiovasc Disord. 2024;24(1):627.
Griffiths S, Behar JM, Lascelles K, Wong T. The fatal consequence of inappropriate therapy in a single VF zone primary prevention defibrillator. Pacing Clin Electrophysiol. 2021;44(4):740-3.
Lv G, Zhao X, Xu X, Hou F, Li P. Gender-Based Differences in the Relationships Among Social Support, Positive Psychological Capital, and Sleep Quality in Patients Implanted With Pacemakers: A Moderated Mediation Model. J Cardiovasc Nurs. 2022;37(1):79-85.
Mlynarski R, Mlynarska A, Golba KS. The impact of cardiac pacemaker implantation on male sexual function. Pacing Clin Electrophysiol. 2020;43(12):1508-14.
Grant JK, Vincent L, Ebner B, Maning J, Singh H, Olorunfemi O, et al. In-Hospital Outcomes in Patients With a History of Malignancy Undergoing Transcatheter Aortic Valve Implantation. Am J Cardiol. 2021;142:109-15.
El-Shakankery KH, Mieiro L. A key role for comprehensive geriatric assessment in aortic valve replacement. BMJ Case Rep. 2020;13(12).
Bencardino G, Scacciavillani R, Narducci ML. Leadless pacemaker technology: clinical evidence of new paradigm of pacing. Rev Cardiovasc Med. 2022;23(2):43.
Magliano PL, Scotto Di Uccio F, Persico R, Provvisiero C, Ricciardi P, Ducceschi V. Managing a Mental Disorder With New Technologies: TheLeadless Pacemaker in Reel's Syndrome, a Case Report. Pacing Clin Electrophysiol. 2025;48(2):235-8.
Yusufov M, Pirl WF, Braun I, Tulsky JA, Lindvall C. Natural Language Processing for Computer-Assisted Chart Review to Assess Documentation of Substance use and Psychopathology in Heart Failure Patients Awaiting Cardiac Resynchronization Therapy. J Pain Symptom Manage. 2022;64(4):400-9.
Khalil M, Hashim A, Maraey A, Saeyeldin A, Elzanaty AM, Biskupski P, et al. Outcomes of conventional pacemaker implantation in patients with dementia: insights from the National Readmission Database. J Interv Card Electrophysiol. 2022;64(3):559-61.
Guan F, Peng J, Hou S, Ren L, Yue Y, Li G. Periprocedural complications of cardiac implantable electronic device implantation in very elderly patients with cognitive impairment: A prospective study. Medicine (Baltimore). 2021;100(46):e27837.
Turton E. Psychological distress beyond anxiety and depression in a population with cardiac devices : inclusive of those with pacemakers. 2015.
Allam L, Nabih M, El-Missiry M. The psychological impact of permanent cardiac pacemakers on pediatric patients and their parents: A case control study. Indian Heart Journal. 2018;70:872-8.
Qi-Fang W. Psychological Intervention for Mood Disorders after Implantation of Cardiac Pacemakers. Journal of Nanchang University. 2013.
Figueroa C, Alcocer L, Ramos B. Psychological Intervention to Modify Anxiety, Depression and Quality of Life in Patients with an Implantable Pacemaker. Psychology. 2016;07:374-81.
Negishi Y, Aoki Y, Itomi K, Yasuda K, Taniguchi H, Ishida A, et al. SCN8A-related developmental and epileptic encephalopathy with ictal asystole requiring cardiac pacemaker implantation. Brain Dev. 2021;43(7):804-8.
Sawicki S, Mierzyńska A, Krauze A, Dobrowolski P, Świerżyńska E, Prejbisz A, et al. Silent atrial fibrillation episodes and cognitive impairment in patients with cardiac implantable devices. Protocol of the SAFE-COG ongoing observational single-center non-experimental case-control clinical study. Kardiol Pol. 2021;79(12):1362-4.
Bürker BS, Hardersen RI, Lappegård KT. Symptoms of Depression, Anxiety, and Posttraumatic Stress among Patients with Cardiac Pacemakers. Int J Environ Res Public Health. 2022;19(24).
Khan MZ, Khan MU, Syed M, Balla S. Trends in Microbiology Data and Association With Mortality in Infective Endocarditis (2002-2017). Am J Cardiol. 2021;142:155-6.
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Copyright (c) 2025 Muhammad Qasim Arif, Juwairia Abdul Rahim, Wajeeha Ahmadani, Muhammad Ehtesham, Komal Khan, Aleeha Afreenish Zab, Umm e Habibah Azeez Qureshi (Author)
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