A 35-year-old female patient was admitted two times to the Behavior Medicine ward of the Department of Psychiatry, Division of Social Psychiatry, of the University of Vienna, Austria, for panic disorder with severe agoraphobia. Tachyarrhythmias have been diagnosed in the patient at the age of 3. Because of the cardiac disease, a pacemaker and a defibrillator were implanted. The first panic attack occurred at the age of 33 and could clearly be distinguished by the patient from occurring tachyarrhythmias. During the first inpatient treatment, the patient underwent a cognitive-behavioral therapy including single and group therapy sessions, exposure in sensu and in vivo as well as applied relaxation. After discharge, the patient re-experienced panic attacks and numerous life-saving defibrillations, leading to a second admission. Again, she was treated with cognitive therapy including single and group therapy sessions, exposure therapy, and applied relaxation in addition to an SSRI medication. A follow-up 5 month after discharge showed that the therapy was successful in eliminating the panic disorder with agoraphobia. During this time no defibrillations occurred.

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