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Diagnosis of a cardiac genetic disorder can be a life-changing event. Symptomatic status, uncertainty regarding disease progression, risk of sudden cardiac death (SCD), recommended lifestyle changes (ie, activity restrictions or career change), and genetic transmission to offspring all contribute to the potential psychological burden of disease. Most of the relevant literature on this topic focuses on 2 of the most common genetic cardiac diseases, hypertrophic cardiomyopathy and inherited long-QT syndrome. Studies on these disorders have consistently shown impairments in health status and quality of life, with an elevated risk for anxiety and depression.1–4 An implantable cardioverter defibrillator (ICD) may be indicated for primary or secondary prevention of SCD in these patients, and is likely to exacerbate psychological distress. Independent of underlying diagnosis, patients requiring ICDs commonly experience anxiety and/or depression related to the anticipation of a potential shock.5,6 Psychological implications of ICDs have been reported to be worse in patients with inherited diseases compared with ischemic or valvular heart disease.7 The experience of receiving 1 or more ICD shocks further negatively affects quality of life.7,8 Inappropriate shocks (ie, for sinus or supraventricular tachycardia or T-wave oversensing) can elicit similar psychological responses to appropriate shocks for life-threatening ventricular arrhythmias. This is a particularly important consideration for young patients because 1 in 4 may be expected to receive at least 1 inappropriate shock.9Article see p 18Like hypertrophic cardiomyopathy and long-QT syndrome, a diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC) carries the psychological burden of genetic transmission and risk of SCD, …

Anxiety in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy and Implantable Cardioverter Defibrillators