Impact of Cardiac Implantable Electronic Devices on Sexual Function in Males: A Systematic Review

Abstract

Introduction The implantation of cardiac implantable electronic devices (CIEDs) to regulate cardiac function is an important treatment for preventing life-threatening cardiac arrhythmias and reducing mortality. However, such device implantation may affect multiple aspects of quality of life, particularly sexual function in male, which is an issue often overlooked in patient care. 

Objective This study aimed: (1) to examine the impact of cardiac implantable electronic devices on sexual function in male patients, and (2) to identify factors that positively and negatively influence sexual function in male patients with implanted cardiac electronic devices. 

Design This study employed a systematic review. 

Methodology The studies included in this review were identified through searches of seven databases in both Thai and English: THAIJO, PubMed, CINAHL (EBSCO), ProQuest, Wiley Online Library, ScienceDirect, and the Cochrane Library from 2014–2024. The inclusion criteria were determined using the Population–Exposure–Outcome (PEO) framework. Population consisted of males aged 20 years and older who had undergone cardiac implantable electronic device implantation and received care at hospitals. Exposure was cardiac implantable electronic devices (CIEDs), including implantable cardioverter defibrillators (ICDs), cardiac resynchronization therapy (CRT), and permanent pacemakers (PPMs). Outcome was sexual function, including both positive outcomes such as improvement in erectile function, decreased orgasmic problems, and increased sexual satisfaction and negative outcomes, including an inability to reach orgasm, decreased sexual desire, and reduced satisfaction with sexual activity. Studies were screened by title and abstract and then full-text review. Two researchers independently appraised study quality and extracted data using the Joanna Briggs Institute (JBI) critical appraisal tools. Both researchers also validated the accuracy of data extraction and quality assessment. Studies that did not meet the inclusion criteria or were of low quality were excluded. In cases where the two researchers disagreed, a consultation with an expert was sought to reach a consensus. Because the included studies measured sexual function at different time points following device implantation and used varying assessment tools, the data were synthesized using a narrative summary approach.

Results A total of five studies were included in the systematic review, with data collected from five countries: Denmark, the United States, Switzerland, Turkey, and Poland. No studies on this topic were found that collected data in Thailand or other Asian countries. Four of the studies employed crosssectional designs, and one was a noncomparative observational study. All participants were male, totaling 901. The instruments used to assess sexual function included the International Index of Erectile Function15 (IIEF15), the International Index of Erectile Function5 (IIEF5), the Sexual Health Inventory for Men (SHIM), and the Sexual Confidence Index (SCI). Findings from this systematic review indicate that: (1) different types of CIEDs have varying effects on sexual function. Implantation of ICDs was associated with negative impacts, including inability to achieve orgasm, decreased sexual desire, reduced sexual satisfaction, lower overall satisfaction, erectile difficulties, and reduced frequency of sexual activity. In contrast, implantation of CRT and PPM devices was associated with positive effects, such as decreased severity of erectile dysfunction, reduced difficulty achieving orgasm, increased sexual satisfaction, and improved overall satisfaction. (2) Negative factors influencing sexual function included age, anxiety, and various fears stemming from patients’ symptoms, concerns about device malfunction, and especially lack of confidence in the operation of ICDs. Positive factors included reduced anxiety and increased senses of security and confidence associated with CRT and PPM devices.

Recommendation The implantation of cardiac implantable electronic devices (CIEDs) in male has both positive and negative impacts on sexual function, particularly among those with ICDs, who frequently experience fear and anxiety, factors that adversely affect their sexual function. Therefore, patient care should not focus solely on physical treatment but should also include psychological support and interventions that strengthen intimate relationships, in order to promote sustainable improvement in sexual quality of life. This includes establishing teams to provide sexual health counseling or mental health assessment, enhancing interprofessional communication regarding sexual health, and integrating sexual health components into cardiac rehabilitation programs.