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Determinants and trajectory of phobic anxiety in patients living with an implantable cardioverter defibrillator
  1. En-Young Nicole Cho1,
  2. Roland von Känel1,
  3. Birgit Marten-Mittag2,
  4. Joram Ronel2,
  5. Christof Kolb3,
  6. Jens Baumert4,
  7. Karl-Heinz Ladwig2,4
  1. 1Division of Psychosomatic Medicine, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
  2. 2Department of Psychosomatic Medicine and Psychotherapy, University Hospital rechts der Isar, Technische Universität München, Munich, Germany
  3. 3Faculty of Medicine, Department of Cardiovascular Diseases and Electrophysiology, Technische Universität München, German Heart Centre Munich, Munich, Germany
  4. 4Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
  1. Correspondence to Professor Karl-Heinz Ladwig, Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstaedter Landstrasse 1, Neuherberg 85764, Germany; ladwig{at}


Objective The implantable cardioverter defibrillator (ICD) is the gold standard therapy to prevent life-threatening arrhythmias. Phobic anxiety predicts ventricular arrhythmia in coronary heart disease patients, but little is known about phobic anxiety in ICD patients. This study aimed to identify determinants and the course of phobic anxiety in ICD patients.

Patients 140 outpatients living with an ICD (mean age 56±14 years, 66% men).

Main Outcome Measures Phobic anxiety was assessed with the Symptom Checklist-90 Revised at a mean of 27±21 months (range 3–109) post-ICD placement (baseline) and after an average follow-up of 41±18 months (range 10–82). Multivariate linear regression models considered sociodemographic factors, clinical variables and psychological scales as potential determinants of phobic anxiety scores.

Results ICD patients reported more than 10-fold higher levels of phobic anxiety than a previous representative population survey (2.6±3.4 vs 0.2±0.4). Greater age (p=0.003), previous shock experience (p=0.007), depressed mood (p<0.001) and hypochondriasis (p=0.005) were associated with higher phobic anxiety scores at baseline. Multimorbidity (p=0.030) and higher baseline phobic anxiety (p<0.001) determined greater phobic anxiety at follow-up. Younger age (p=0.029) and an elevated number of non-cardiac diseases (p=0.019) were both associated with an increase in phobic anxiety scores from baseline to follow-up. More patients had high phobic anxiety levels (score >4) at follow-up compared with baseline (31% vs 24%; p=0.048).

Conclusions Phobic anxiety was comparably high and persisted over time in ICD patients. Modifiable determinants of phobic anxiety were identified, which may inform tailored interventions to improve ICD patients' distress and perhaps also prognosis.

  • Anxiety
  • arrhythmias
  • atrial fibrillation
  • bradycardia
  • cardiovascular disease
  • coagulation factors
  • coronary artery disease
  • defibrillation
  • depression
  • education
  • epidemiology
  • implantable cardioverter defibrillator (ICD)
  • pacemakers
  • psychological stress
  • psychology/psychiatry
  • public health

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  • Funding The study was financially supported by grant 8836702/03 from the Deutsche Forschungsgemeinschaft (DFG) and by grant KKF-H 18-97 from the Medical Faculty of the Technische Universität München (TUM) (to KHL).

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was obtained from the Medical Faculty of the Technical University of Munich.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Online survey completed.