Shock-related anxiety and sexual function in adults with congenital heart disease and implantable cardioverter-defibrillators

BACKGROUND: An increasing number of adults with congenital heart disease (CHD) require implantable cardioverter-defibrillators (ICDs),yet little is known about their impact on psychological well-being and sexual function. OBJECTIVE: To assess shock-related anxiety in adults with CHD and its association with depression and sexual function. METHODS: A prospective, multicenter, cross-sectional study was conducted on adult patients with CHD with (ICD ⁺) and without (ICD^-) ICDs. The Florida Shock Anxiety Scale was administered to patients with ICD⁺ and the Beck Depression Inventory-II to all patients. Men completed the Sexual Health Inventory for Men, and women completed the Female Sexual Function Index. RESULTS: A total of 180 adults with CHD (ICD⁺: n = 70; ICD^-: n = 110; median age 32 years [interquartile range 27-40 years]; 44% women) were enrolled. The complexity of CHD was classified as mild in 32 (18%), moderate in 93 (52%), and severe in 54 (30%) subjects. In ICD recipients, a high level of shock-related anxiety was identified (Florida Shock Anxiety Scale score 16; interquartile range 12-23.5), which was slightly higher than the median score for ICD recipients in the general population (P = .057). A higher level of shock-related anxiety was associated with poorer sexual function scores in both men (Spearman's ρ = -.480; P < .001) and women (Spearman's ρ = -.512; P < .01). It was also associated with self-reported depressive symptomatology (Spearman's ρ = .536; P < .001). CONCLUSIONS: Adults with CHD and ICDs demonstrate a high level of shock-related anxiety, which is associated with lower sexual functioning scores in men and women. These results underscore the need for increased clinical attention related to ICD-related shock anxiety and impaired sexual function in this population.