Electrophysiologic characteristics of anger-triggered arrhythmias

Stopper, Matthew; Joska, Tammy M.; Burg, Matthew M.; Batsford, William P.; McPherson, Craig A.; Jain, Diwakar; Lampert, Rachel

doi:10.1016/j.hrthm.2006.11.003

Cited by 29 publications

(21 citation statements)

References 31 publications

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“…We have also found that emotion/stress-triggered arrhythmias are particularly malignant in morphology (20), and therefore more likely to require shock for termination. Thus, we have identified a potential target for treatment – mental/emotional stress - to reduce vulnerability to arrhythmias requiring shock for termination in patients with an ICD.…”

mentioning

confidence: 59%

Rationale and Design of a Randomized Clinical Trial Comparing Stress Reduction Treatment to Usual Cardiac Care: The Reducing Vulnerability to Implantable Cardioverter Defibrillator Shock-Treated Ventricular Arrhythmias (RISTA) Trial

Donahue

Lampert²,

Dornelas³

et al. 2010

Psychosomatic Medicine

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Objective-Present the design of a multicenter randomized trial testing the effects of Stress Reduction Treatment (SRT) on the prevalence of shock treated ventricular arrhythmias among patients with an implantable cardioverter defibrillator (ICD). Significant adjustment problems secondary to ICD shock can increase the likelihood of arrhythmias requiring shock for termination. Whether SRT can reduce arrhythmias requiring shock for termination in patients with ICDs has not been tested in clinical trials.Methods-New ICD recipients and previous recipients who have received an appropriate therapeutic shock in the past 6 months (n=304) will be enrolled and randomized to either SRT or usual cardiac care. Participants complete a psychosocial questionnaire and undergo laboratory mental stress testing and 24-hour holter monitoring with diary at study entry and approximately 4 months later. Follow-ups are completed at 6-, 12-, and 24-months post randomization to assess occurrence of ICD shock for ventricular arrhythmias (primary outcome), ATP events, medication changes, hospitalizations, deaths, and quality of life.Results-Log-rank test and Cox proportional hazards model will be used to test the effects of SRT on time to first shock treated ventricular arrhythmia, with exploratory analyses testing the effects on overall frequency of ventricular arrhythmia. Secondary analyses will test the effects of SRT on lab stress induced and 24-hour arrhythmogenic electrophysiological indices from pre-to post-treatment, and both quality of life and measures of anger across the 2-years of the study.Conclusions-The RISTA Trial is the first large scale randomized clinical trial designed to evaluate the effect of SRT on the prevalence of shock-treated arrhythmias among patients with an ICD. Results may demonstrate a treatment that can reduce vulnerability to arrhythmia provoked shock and improve quality of life.Correspondence: Matthew M. Burg, Ph.D., Yale University School of Medicine, Internal Medicine-Cardiology, 333 Cedar Street, FMP 3, New Haven, Connecticut 06520; Phone 203-937-3882; Fax 203-937-3884; mb2358@columbia.edu.. RISTA is registered at ClinicalTrials.gov: NCT00627263 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. (2) or induced (3) life-threatening ventricular arrhythmias -the original targets of this therapy -but also for primary prevention in patients with impaired left ventricular (LV) function due to either ischemic or non-ischemic cardiomyopathies accompanied by congestive heart failure (4-6). These trials have led to expansions of the initial indications for ICD therapy, and with the recent...

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mentioning

confidence: 59%

Rationale and Design of a Randomized Clinical Trial Comparing Stress Reduction Treatment to Usual Cardiac Care: The Reducing Vulnerability to Implantable Cardioverter Defibrillator Shock-Treated Ventricular Arrhythmias (RISTA) Trial

Donahue

Lampert²,

Dornelas³

et al. 2010

Psychosomatic Medicine

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“…The induction of anger in patients with coronary artery disease during laboratory mental stress tests increases the likelihood of developing T wave alternans (Kovach et al, 2001; Kop et al, 2004). Anger triggered ventricular arrhythmias in patients with ICDs are more likely to be pause dependent and polymorphic suggesting that anger may create a substrate for more disorganized rhythms (Stopper et al, 2007). Even anger recall in patients mainly with cardioverter defibrillators (CAD) during non-invasive EP studies can make ventricular arrhythmias easier to induce and more difficult to terminate (Lampert et al, 2000).…”

Section: Angermentioning

confidence: 99%

Anger, Emotion, and Arrhythmias: From Brain to Heart

Taggart¹,

Boyett²,

Logantha³

et al. 2011

Front. Physio.

101

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Strong emotion and mental stress are now recognized as playing a significant role in severe and fatal ventricular arrhythmias. The mechanisms, although incompletely understood, include central processing at the cortical and brain stem level, the autonomic nerves and the electrophysiology of the myocardium. Each of these is usually studied separately by investigators from different disciplines. However, many are regulatory processes which incorporate interactive feedforward and feedback mechanisms. In this review we consider the whole as an integrated interactive brain–heart system.

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“…They described that psychological status assessed by different quality-of-life instruments can predict mortality in patients with a history of life-threatening ventricular arrhythmias [13]. In accordance, anger has been identified as a precipitator in another cohort of patients with ICDs [14]. In the cited study, ventricular arrhythmias which occurred in the setting of emotional distress were more likely to be pause dependent and rather polymorphic than monomorphic.…”

Section: Psychopharmacotherapy and Cardiovascular Side Effectsmentioning

confidence: 89%

“…In the cited study, ventricular arrhythmias which occurred in the setting of emotional distress were more likely to be pause dependent and rather polymorphic than monomorphic. The authors speculate based on these observations that anger may lead to a more disorganised arrhythmogenic substrate as the underlying link of emotional distress and sudden cardiac death [14].…”

Section: Psychopharmacotherapy and Cardiovascular Side Effectsmentioning

confidence: 99%

Panic attacks and supraventricular tachycardias: the chicken or the egg?

2012

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Panic attacks occur in about 2 % of the population. Symptoms include a racing or pounding heart beat, chest pain, dizziness, light-headedness, nausea, difficulty in breathing, tingling or numbness in the hands, flushes or chills, dreamlike sensations or perceptual distortions. The symptoms of paroxysmal supraventricular tachycardia (PSVT) may be similar. A PSVT is often difficult to document on the ECG since it has often ceased before the patient comes to medical attention. Besides, a tachycardia may still be present and even be documented but interpreted as a phenomenon secondary to the panic attack. In addition, ECG abnormalities between episodes can often not be identified. The evidence that in some patients paroxysmal SVT is the cause, but not the consequence of a panic attack, is based on observations that catheter ablation was able to cure patients presenting with panic disorders. To better establish the prevalence of SVT as the underlying mechanism of a panic attack, there is a need for prospective studies and/or registries. Whereas gastric ulcer has in some patients changed from a psychosomatic disorder to an infectious disease, we may hypothesise that a certain proportion of panic disorders may mutate into an underlying arrhythmia rather than a primary psychiatric disorder.

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Electrophysiologic characteristics of anger-triggered arrhythmias

Cited by 29 publications

References 31 publications

Rationale and Design of a Randomized Clinical Trial Comparing Stress Reduction Treatment to Usual Cardiac Care: The Reducing Vulnerability to Implantable Cardioverter Defibrillator Shock-Treated Ventricular Arrhythmias (RISTA) Trial

Rationale and Design of a Randomized Clinical Trial Comparing Stress Reduction Treatment to Usual Cardiac Care: The Reducing Vulnerability to Implantable Cardioverter Defibrillator Shock-Treated Ventricular Arrhythmias (RISTA) Trial

Anger, Emotion, and Arrhythmias: From Brain to Heart

Panic attacks and supraventricular tachycardias: the chicken or the egg?

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