Psychological factors and cardiac repolarization instability during anger in implantable cardioverter defibrillator patients

Annals of noninvasive electrocardiology: the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc

article

David S. Krantz¹  Kristie M. Harris²  Heather L. Rogers³  Kerry S. Whittaker⁵  Mark C. P. Haigney⁶  Willem J. Kop⁷ 

[1] Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences;Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine;Biocruces Bizkaia Health Research Institute;Ikerbasque Basque Foundation for Science;Research Facilitation Laboratory – Army Analytics Group;Division of Cardiology, Department of Medicine, Military Cardiovascular Outcomes Research (MiCOR), Uniformed Services University of the Health Sciences;Department of Medical Psychology and Neuropsychology, Tilburg University

关键词: anger;    arrhythmia;    QT variability index;    repolarization instability;   

DOI  :  10.1111/anec.12848

来源: Wiley

【 摘 要 】

Background Evidence indicates that emotions such as anger are associated with increased incidence of sudden cardiac death, but the biological mechanisms remain unclear. We tested the hypothesis that, in patients with sudden death vulnerability, anger would be associated with arrhythmic vulnerability, indexed by cardiac repolarization instability. Methods Patients with coronary artery disease (CAD) and an implantable cardioverter defibrillator (ICD; n  = 41) and healthy controls ( n  = 26) gave an anger-inducing speech (anger recall), rated their current (state) anger, and completed measures of trait (chronic) levels of Anger and Hostility. Repolarization instability was measured using QT Variability Index (QTVI) at resting baseline and during anger recall using continuous ECG. Results ICD patients had significantly higher QTVI at baseline and during anger recall compared with controls, indicating greater arrhythmic vulnerability overall. QTVI increased from baseline to anger recall to a similar extent in both groups. In ICD patients but not controls, during anger recall, self-rated anger was related to QTVI ( r  = .44, p  = .007). Trait (chronic) Anger Expression ( r  = .26, p  = .04), Anger Control ( r  = −.26, p  = .04), and Hostility ( r  = .25, p  = .05) were each associated with the change in QTVI from baseline to anger recall (ΔQTVI). Moderation analyses evaluated whether psychological trait associations with ΔQTVI were specific to the ICD group. Results indicated that Hostility scores predicted ΔQTVI from baseline to anger recall in ICD patients (β = 0.07, p  = .01), but not in controls. Conclusions Anger increases repolarization lability, but in patients with CAD and arrhythmic vulnerability, chronic and acute anger interact to trigger cardiac repolarization lability associated with susceptibility to malignant arrhythmias.

【 授权许可】

Unknown