Abstract
We present herein three cases with complications which required psychosomatic approaches during device therapies for arrhythmias. The first case is a 55-year-old female patient with sick sinus syndrome, who underwent permanent pacemaker implantation. She complained of dysphagia, dysphonia, and severe left arm pain and paralysis, and was diagnosed as having reflex sympathetic dystrophy. She lost her job and became depressed. Some sessions with physical and occupational therapists helped her recover from the depression. The second case is a 62-year-old female patient who was implanted with an implantable cardioverter-defibrillator (ICD). ICD was infected. However, local infection was controlled by intensive chemotherapy without reoperation. Her reactive depression was improved by peer-support from ICD support group. The third case is a 48-year-old female patient with hereditary long QT syndrome. She repeatedly complained of left arm phantom swelling after implantation with ICD. She was diagnosed as having transient hypochondriasis upon psychiatric consultation. Her psychiatric condition improved after explaining the result of thoracic computed tomography (CT), which was performed in the presence of a cardiac device representative (CDR). Although CT was not an ideal resolution of her hypochondriasis, this promoted her own awareness of the psychosomatic linkage. These three cases were didactic for cardiac device complications, which often require multidisciplinary psychosomatic approaches.
