PSYCHIATRIC COMORBIDITIES IN PATIENTS WITH CARDIAC PACEMAKERS: A NARRATIVE REVIEW

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.