The published study provides an important scale, already in its Brazilian Portuguese version and that has been validated for our population, which allows assessing the level of anxiety related to the presence of the Implantable Cardioverter-Defibrillator (ICD) and the shocks applied by the device. 1 This scale, as well emphasized in the study by Silva et al., 1 was not designed to assess aspects of the patient's adaptation to the ICD, or even its impacts on patient quality of life, and there is

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... another scale that is appropriate for this purpose, such as the FPAS -Florida Patient Acceptance Survey. 2 The article reminds us of the importance of appreciating the psychosocial aspects of patients with an ICD that are often relegated to a secondary plan. Several articles have demonstrated the negative impact that the presence of the ICD, even without therapies, can have on these patients' lives. [3] [4] [5] However, we know about the undeniable clinical benefits they bring in different clinical contexts. 6 Therefore, a psychosocial approach should be part of the arrhythmia and pacemaker outpatient clinics, considering we now have a tool for such analysis available in our country. Manzoni et al. 7 analyzed sixty studies and assessed the level of anxiety, depression, health-related quality of life, posttraumatic stress syndrome and psychiatric disorders in patients with ICD. They concluded there is a large methodological heterogeneity in the psychological tests used. This has made data analysis difficult and, consequently, has hindered strategies to reduce this impact. Several factors can influence the degree of anxiety and are not fully addressed in these studies, such as the different demographic characteristics, the pre-implantation clinical and psychological status and the number of shocks, whether appropriate or not. 7