Emotional and Physical Precipitants of Ventricular Arrhythmia

Abstract

Background-Observational studies have suggested that psychological stress increases the incidence of sudden cardiac death. Whether emotional or physical stressors can trigger spontaneous ventricular arrhythmias in patients at risk has not been systematically evaluated. Methods and Results-Patients with implantable cardioverter-defibrillators (ICDs) were given diaries to record levels of defined mood states and physical activity, using a 5-point intensity scale, during 2 periods preceding spontaneously occurring ICD shocks (0 to 15 minutes and 15 minutes to 2 hours) and during control periods 1 week later. ICD-stored electrograms confirmed the rhythm at the time of shock. A total of 107 confirmed ventricular arrhythmias requiring shock were reported by 42 patients (33 men; mean age, 65 years; 78% had coronary artery disease) between August 1996 and September 1999. In the 15 minutes preceding shock, an anger level Ն3 preceded 15% of events compared with 3% of control periods (PϽ0.04; odds ratio, 1.83; 95% confidence intervals, 1.04 to 3.16) Other mood states (anxiety, worry, sadness, happiness, challenge, feeling in control, or interest) did not differ. Patients were more physically active preceding shock than in control periods. Anger and physical activity were independently associated with the preshock period. Conclusions-Anger and physical activity can trigger ventricular arrhythmias in patients with ICDs. Future investigations of therapies aimed at blocking a response to these stressors may decrease ventricular arrhythmias and shocks in these

Psychological vulnerability, ventricular tachyarrhythmias and mortality in implantable cardioverter defibrillator patients: is there a link?

“…Based on the responses, the calculated relative risk of arrhythmia recurrence associated with mental stress was 9.5 (95% CI: 6.3-14.5). In another study, 42 ICD patients were asked to complete a diary page when they experienced a shock to retrospectively evaluate their mood state in the 15 min preceding the shock [35]. Results showed that moderate levels of anger were more likely during the period preceding shock than during a matched control period 1 week later.…”

“…Patients with depression and anxiety tend to have impaired vagally mediated baroflex control of the heart and an increase in sympathetic tone, characterized by an increased level of norepinephrine [46], a decrease in heart rate variability [47,48] and abnormal heart rate turbulence [49]. These parameters that reflect imbalance in autonomic tone have been implicated in the onset of cardiac events, including ventricular fibrillation, ventricular arrhythmias and mortality in ICD patients [35,43,50], and in patients postmyocardial i nfarction [49,51].…”

Heart Rate Variability, Catecholamine and Hemodynamic Responses During Rest and Stress in Coronary Artery Disease Patients: The PIMI Study

“…This may lead to an increased demand for oxygen by the heart and myocardial ischemia (Ramachandruni et al, 2006). Sympathetic activation may also decrease the threshold for arrhythmic vulnerability (Lampert et al, 2002;Lampert et al, 2005). These relationships may be more pronounced in patients with known CHD.…”

“…Coronary heart disease may lead to myocardial ischemia (inadequate blood supply to the heart muscle), MI, malignant arrhythmias and subsequent cardiac arrest (Krantz, Kop, Santiago, & Gottdiener, 1996;Krantz et al, 1999;Lampert et al, 2002).…”

Scared to Death

“…2,3 Some suggest that nearly 20% of all arrhythmic episodes and sudden cardiac death events are triggered by an intense emotional event. 4 The adverse effects of an acute emotional response are confounded when patients have preexisting illness associated with chronically elevated sympathetic nervous system activity such as chronic heart failure, cardiac ion channelopathy, or disease states requiring sympathomimetic therapies (e.g., asthma).…”