The Marriage of True Minds: The Partner of the ICD Patient as a New Focus for Study

One may forget that implantable cardioverter defibrillator (ICD) therapy represents a clinical message of therapeutic nihilism. After a close to 20-year effort (from The Multiple Risk Factor Intervention Trial [MRFIT] to Cardiac Arrhythmia Suppression Trial [CAST]), the electrophysiology (EP) community has thrown up its hands in defeat to the wiles of biology. It has conceded that the effort to accurately identify and protect patients from sudden cardiac death has failed. Instead the focus has changed to the humble but more realistic goal of preventing an anticipated, but not prospectively identified, episode of ventricular tachycardia/ventricular fibrillation from becoming fatal. For recipients of ICD therapy, this has led to a tradeoff between the advantages of such protection against the “cost” of our collective ignorance. Part of this “cost” has been noted in studies performed over the last 15 years of health-related quality of life (HR-QOL) and the psychological effects of ICDs on recipients. Left relatively unexplored, however, has been the effect on partners of ICD recipients. Shakespeare suggested (in sonnet 116): “Let us not to the marriage of true minds admit impediment. Love is not love/which alters when it alteration finds.” It is difficult to think of a more profound “alteration” for a partner than the receipt of an ICD and its inherent mixed message of frailty and protection. Marriage is the most central relation for most adult ICD recipients and has an important impact on psychological health and related to these impacts on health and disease. The effect of marriage on health has had long study. Most contemporary research would suggest it is the nature of relationship between two adults that constitutes the healthnurturing outcome of contemporary couples. The role of marriage in health has most recently been summarized in a review article in the New York Times1 that emphasizes the cardiovascular and general-health outcomes of marriages when