Prevalence of anxiety and risk associated with ventricular arrhythmia in patients with an implantable cardioverter defibrillator

Abstract

Background: Anxiety has been associated with adverse clinical outcomes in patients who have received an implantable cardioverter defibrillator (ICD). However, results are inconclusive likely due to different measures being used to assess anxiety. Hence, the current study aims to examine the prevalence and the association between anxiety, ventricular tachyarrhythmia's (VTa's) and all-cause mortality, respectively. Methods: Patients who received an ICD for the first time were recruited from 6 Dutch referral hospitals as part of the WEBCARE trial. Patients filled in validated questionnaires (GAD-7, STAI-S, HADS-A, ANX4, ICDC, FSAS) to assess their baseline anxiety symptomatology. Logistic regression analysis and Cox Regression analysis were performed to examine the association between anxiety with 1) VTa's and 2) mortality, respectively. Results: A total of 214 Patients were included in the analysis with mean age 58.9 and 82.7% being male. The prevalence rates of anxiety varied depending on which questionnaire was used 12.4% (GAD-7), 17.5% (HADS-A), and 28.1% (STAI-S). (Cox) Regression analysis revealed that none of the anxiety measures was associated with VTa's or all-cause mortality in the current sample. Stratifying the sample by gender, the analysis showed that GAD-7, STAI-S, and ANX4 scores were associated with increased risk of VTa's but only in male patients. Conclusions: Prevalence rates of anxiety varied depending on the measurement tool used. No significant association between anxiety and VTa's and all-cause mortality was observed in the total sample. GAD-7, STAI-S, and ANX4 were associated with increased risk for VTa's but only in male patients.

The Impact of Cardiac Devices on Patients’ Quality of Life—A Systematic Review and Meta-Analysis

“…Hereby, the prevalence of anxiety disorders and depressive symptoms is estimated to be approximately 20% in ICD patients according to a large meta-analysis from 2011 [ 6 ]. These findings were supported by a multicenter trial by Habibovíc et al in 2020 [ 69 ]. However, anxiety could not be connected to the risk for ventricular arrhythmias or mortality [ 69 ].…”

“…These findings were supported by a multicenter trial by Habibovíc et al in 2020 [ 69 ]. However, anxiety could not be connected to the risk for ventricular arrhythmias or mortality [ 69 ]. Pedersen et al presented data on 332 patients, which showed stable psychological functioning in most patients receiving an ICD after 12 months [ 70 ].…”

Examination of Tp-e interval, Tp-e / QT ratio, Tp-e / QTc ratio and fragmented QRS parameters in patients diagnosed with generalized anxiety disorder

“…In addition, increased Tp-e interval and Tp-e/QT ratio were associated with cardiovascular mortality (23). Habibovic et al (24) stated in a study they conducted in 2020 that anxiety causes ventricular arrhythmia but has no effect on mortality. In our study, we found that the Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio, which are indicators of ventricular repolarization, were higher in individuals with a diagnosis of GAD compared to the healthy control group.…”

Psychosocial symptoms of ventricular arrhythmias: Integrating patient-reported outcomes into clinical care

“…48 A more recent study noted higher anxiety scores on certain PROMs was associated with increased risk of recurrent VAs, but only in males. 49 Based on the above data, clinicians should consider screening for anxiety and depression with PROMs either routinely, or selectively among patients who have had VT storm or 5 or more ICD shocks. Patients with clinically elevated symptoms should have concerns addressed by their Device Clinic team, including a written "ICD Shock Plan" that explicitly states the criteria for which a patient should notify the clinic and/or seek medical attention after ICD shock(s).…”