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Kurnick A, Ahmed A, Gonzalez J, Budzikowski AS. A Rare Case of a Panic Attack Inducing a Junctional Escape Rhythm on ECG. Cureus 2023; 15:e40677. [PMID: 37485191 PMCID: PMC10357390 DOI: 10.7759/cureus.40677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/25/2023] Open
Abstract
We present a unique and rare case of a young female patient who presented with complaints typical of her prior panic attacks and was found to have a junctional escape rhythm on ECG. Upon resolution of her symptoms, a repeat ECG demonstrated a return to normal sinus rhythm. Given that alternative etiologies had been ruled out, it was postulated that her panic attack induced a transient junctional escape rhythm.
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Affiliation(s)
- Adam Kurnick
- Department of Internal Medicine, The State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
| | - Alam Ahmed
- Department of Internal Medicine, The State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
| | - Joseph Gonzalez
- Division of Cardiovascular Medicine - Electrophysiology (EP) Section, The State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
| | - Adam S Budzikowski
- Division of Cardiovascular Medicine - Electrophysiology (EP) Section, The State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
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2
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Abus S, Koparal M, Kaya H, Kapıcı OB, Tasolar MH, Tibilli H. Evaluation of frontal QRS-T angle values in electrocardiography in patients with chronic rhinosinusitis. BMC Cardiovasc Disord 2023; 23:160. [PMID: 36973652 PMCID: PMC10045228 DOI: 10.1186/s12872-023-03175-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 03/09/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Chronic Rhinosinusitis (CRS) refers to inflammation of the paranasal sinuses and nasal mucosa. Electrocardiographic indicators of ventricular repolarization have been shown to correlate with systemic inflammation parameters. Recently, the frontal QRS-T (fQRS-T) angle has been accepted as a new indicator of ventricular depolarization and repolarization heterogeneity. The (fQRS-T) angle is recommended in predicting the risk of malignant ventricular arrhythmia. In this study, we aimed to evaluate the ventricular arrhythmia potential in patients with chronic rhinosinusitis by examining the relationship between fQRS-T angle on ECG and inflammation markers. METHODS Inflammatory markers as well as electrocardiographc (ECG) f(QRS-T) angle, QRS duration, QT interval and corrected QT interval were examined in 54 patients with CRS versus 56 healthy control subjects. RESULTS The f(QRS-T) angle was significantly higher in CRS patients than in healthy controls (p < .001). The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and monocyte-to-lymphocyte ratio (MLR) were significantly higher in CRS patients compared to healthy controls (p < .001, for all). Based on correlation analysis, NLR and f(QRS-T) angles were highly correlated (r = .845, p < .001), and according to the results of linear regression analysis, NLR was independently associated with the f(QRS-T) angle (t = 5.149, Beta = 0.595, p = < 0.001). CONCLUSION Both f(QRS-T) angle and NLR are significantly increased in CRS patients compared to healthy controls, with increases in NLR also independently associating with increases in f(QRS-T) angle. While the increases in f(QRS-T) angle did not result in clinically alarming absolute values for f(QRS-T), CRS patients might nonetheless be at relatively higher risk for malignant cardiac arrhythmias.
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Affiliation(s)
- Sabri Abus
- Department of Cardiology, Adiyaman University Education and Research Hospital, Adiyaman, Turkey
| | - Mehtap Koparal
- Department of Otorhinolaryngology, Adiyaman University Education and Research Hospital, Adiyaman, Turkey
| | - Hakan Kaya
- Department of Cardiology, Adiyaman University Education and Research Hospital, Adiyaman, Turkey.
- Department of Cardiology, Adıyaman Univesity, 416100, Adıyaman, Turkey.
| | - Olga Bayar Kapıcı
- Department of Radiology, Adiyaman University Education and Research Hospital, Adiyaman, Turkey
| | | | - Hakan Tibilli
- Department of Cardiology, Adiyaman University Education and Research Hospital, Adiyaman, Turkey
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Theodorou A, Bakola E, Chondrogianni M, Melanis K, Tsantzali I, Frogoudaki A, Tsivgoulis G. Covid-vaccine-fear-induced paroxysmal atrial fibrillation causing multiple acute arterial infarctions: a case report. Ther Adv Neurol Disord 2022; 15:17562864221094714. [PMID: 35498366 PMCID: PMC9047779 DOI: 10.1177/17562864221094714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Aikaterini Theodorou
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, ‘Attikon’ University Hospital Athens, Athens, Greece
| | - Eleni Bakola
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, ‘Attikon’ University Hospital Athens, Athens, Greece
| | - Maria Chondrogianni
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, ‘Attikon’ University Hospital Athens, Athens, Greece
| | - Konstantinos Melanis
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, ‘Attikon’ University Hospital Athens, Athens, Greece
| | - Ioanna Tsantzali
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, ‘Attikon’ University Hospital Athens, Athens, Greece
| | - Alexandra Frogoudaki
- Second Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine, ‘Attikon’ University Hospital Athens, Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, ‘Attikon’ University Hospital Athens, Rimini 1, Chaidari, 12462 Athens, Greece
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Rosman L, Salmoirago-Blotcher E, Mahmood R, Yang H, Li Q, Mazzella AJ, Lawrence Klein J, Bumgarner J, Gehi A. Arrhythmia Risk During the 2016 US Presidential Election: The Cost of Stressful Politics. J Am Heart Assoc 2021; 10:e020559. [PMID: 34014121 PMCID: PMC8483504 DOI: 10.1161/jaha.120.020559] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Anger and extreme stress can trigger potentially fatal cardiovascular events in susceptible people. Political elections, such as the 2016 US presidential election, are significant stressors. Whether they can trigger cardiac arrhythmias is unknown. Methods and Results In this retrospective case‐crossover study, we linked cardiac device data, electronic health records, and historic voter registration records from 2436 patients with implanted cardiac devices. The incidence of arrhythmias during the election was compared with a control period with Poisson regression. We also tested for effect modification by demographics, comorbidities, political affiliation, and whether an individual's political affiliation was concordant with county‐level election results. Overall, 2592 arrhythmic events occurred in 655 patients during the hazard period compared with 1533 events in 472 patients during the control period. There was a significant increase in the incidence of composite outcomes for any arrhythmia (incidence rate ratio [IRR], 1.77 [95% CI, 1.42–2.21]), supraventricular arrhythmia (IRR, 1.82 [95% CI, 1.36–2.43]), and ventricular arrhythmia (IRR, 1.60 [95% CI, 1.22–2.10]) during the election relative to the control period. There was also an increase in specific types of arrhythmia, including atrial fibrillation (IRR, 1.50 [95% CI, 1.06–2.11]), supraventricular tachycardia (IRR, 3.7 [95% CI, 2.2–6.2]), nonsustained ventricular tachycardia (IRR, 1.7 [95% CI, 1.3–2.2]), and daily atrial fibrillation burden (P<0.001). No significant interaction was found for sex, race/ethnicity, device type, age ≥65 years, hypertension, coronary artery disease, heart failure, political affiliation, or concordance between individual political affiliation and county‐level election results. Conclusions There was a significant increase in cardiac arrhythmias during the 2016 US presidential election. These findings suggest that exposure to stressful sociopolitical events may trigger arrhythmogenesis in susceptible people.
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Affiliation(s)
- Lindsey Rosman
- Division of Cardiology Department of Medicine University of North Carolina at Chapel Hill NC
| | - Elena Salmoirago-Blotcher
- Centers for Behavioral and Preventive Medicine The Miriam Hospital Providence RI.,Schools of Medicine and Public Health Brown University Providence RI
| | - Rafat Mahmood
- Department of Medicine University of North Carolina at Chapel Hill NC
| | - Hannan Yang
- Department of Biostatistics University of North Carolina at Chapel Hill NC
| | - Quefeng Li
- Department of Biostatistics University of North Carolina at Chapel Hill NC
| | - Anthony J Mazzella
- Division of Cardiology Department of Medicine University of North Carolina at Chapel Hill NC
| | - Jeffrey Lawrence Klein
- Division of Cardiology Department of Medicine University of North Carolina at Chapel Hill NC
| | - Joseph Bumgarner
- Rex HospitalUniversity of North Carolina at Chapel Hill Health Raleigh NC
| | - Anil Gehi
- Division of Cardiology Department of Medicine University of North Carolina at Chapel Hill NC
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Abstract
Anger and other negative emotions can precipitate sudden death, as shown in studies of population stressors. Clinical studies of patients with implantable defibrillators demonstrate that anger can trigger ventricular arrhythmias. Long-term negative emotions also increase vulnerability to arrhythmias. Mechanisms linking anger and arrhythmias include autonomic changes, which alter repolarization, possibly enhanced in patients with sympathetic denervation, which in turn trigger potentially lethal polymorphic ventricular tachycardias. Interventions which decrease negative emotions and resultant autonomic responses may be therapeutic in patients with implantable cardioverter defibrillators.
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Finlay M, Harmer SC, Tinker A. The control of cardiac ventricular excitability by autonomic pathways. Pharmacol Ther 2017; 174:97-111. [PMID: 28223225 DOI: 10.1016/j.pharmthera.2017.02.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Central to the genesis of ventricular cardiac arrhythmia are variations in determinants of excitability. These involve individual ionic channels and transporters in cardiac myocytes but also tissue factors such as variable conduction of the excitation wave, fibrosis and source-sink mismatch. It is also known that in certain diseases and particularly the channelopathies critical events occur with specific stressors. For example, in hereditary long QT syndrome due to mutations in KCNQ1 arrhythmic episodes are provoked by exercise and in particular swimming. Thus not only is the static substrate important but also how this is modified by dynamic signalling events associated with common physiological responses. In this review, we examine the regulation of ventricular excitability by signalling pathways from a cellular and tissue perspective in an effort to identify key processes, effectors and potential therapeutic approaches. We specifically focus on the autonomic nervous system and related signalling pathways.
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Affiliation(s)
- Malcolm Finlay
- The Heart Centre, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Charterhouse Square, London EC1M6BQ, UK
| | - Stephen C Harmer
- The Heart Centre, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Charterhouse Square, London EC1M6BQ, UK
| | - Andrew Tinker
- The Heart Centre, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Charterhouse Square, London EC1M6BQ, UK.
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Buckley U, Shivkumar K. Stress-induced cardiac arrhythmias: The heart-brain interaction. Trends Cardiovasc Med 2016; 26:78-80. [PMID: 26051207 PMCID: PMC4662914 DOI: 10.1016/j.tcm.2015.05.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 05/02/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Una Buckley
- UCLA Cardiac Arrhythmia Center, Los Angeles, CA; UCLA Neurocardiology Research Center of Excellence, David Geffen School of Medicine, Los Angeles, CA
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, Los Angeles, CA; UCLA Neurocardiology Research Center of Excellence, David Geffen School of Medicine, Los Angeles, CA.
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Abstract
Psychological stress can lead to atrial and ventricular arrhythmias, but the physiological pathways have not been fully elucidated. Signal processing techniques can provide insight into electrophysiological mechanisms of stress-induced arrhythmia. T-wave alternans, as well as other ECG measures of heterogeneity of repolarization, increases with emotional and cognitive stress in the laboratory setting, and may also in "real life" settings. In the atrium, stress impacts components of the signal-averaged ECG. These changes suggest mechanisms by which everyday stressors can lead to arrhythmia.
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Finlay MC, Lambiase PD, Ben-Simon R, Taggart P. Effect of mental stress on dynamic electrophysiological properties of the endocardium and epicardium in humans. Heart Rhythm 2015; 13:175-82. [PMID: 26272521 PMCID: PMC4703839 DOI: 10.1016/j.hrthm.2015.08.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND Striking temporal associations exist between ventricular arrhythmia and acute mental stress, for example, during natural disasters, or defibrillator shocks associated with stressful events. We hypothesized that electrophysiological changes in response to mental stress may be exaggerated at short coupling intervals and hence relevant to arrhythmia initiation. OBJECTIVE The aim of this study was to determine the dynamic response in human electrophysiology during mental stress. METHODS Patients with normal hearts and supraventricular tachycardia underwent electrophysiological studies avoiding sedation. Conditions of relaxation and stress were induced with standardized psychometric protocols (mental arithmetic and anger recall) during decremental S1S2 right ventricular (RV) pacing. Unipolar electrograms were acquired simultaneously from the RV endocardium, left ventricular (LV) endocardium (LV endo), and epicardium (LV epi), and activation-recovery intervals (ARIs) computed. RESULTS Twelve patients ( 9 women; median age 34 years) were studied. During stress, effective refractory period (ERP) reduced from 228 ± 23 to 221 ± 21 ms (P < .001). ARIs reduced during mental stress (P < .001), with greater reductions in LV endocardium than in the epicardium or RV endocardium (LV endo -8 ms; LV epi -5 ms; RV endo -4 ms; P < .001). Mental stress depressed the entire electrical restitution curve, with minimal effect on slope. A substantial reduction in minimal ARIs on the restitution curve in LV endo occurred, commensurate with the reduction in ERP (LV endo ARI 195 ± 31 ms at rest to 182 ± 32 ms during mental stress; P < .001). Dispersion of repolarization increased sharply at coupling intervals approaching ERP during stress but not at rest. CONCLUSION Mental stress induces significant electrophysiological changes. The increase in dispersion of repolarization at short coupling intervals may be relevant to observed phenomena of arousal-associated arrhythmia.
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Affiliation(s)
- Malcolm C Finlay
- University College London, Queen Mary University of London & St Bartholomew's Hospital, London, United Kingdom
| | - Pier D Lambiase
- University College London, Queen Mary University of London & St Bartholomew's Hospital, London, United Kingdom
| | - Ron Ben-Simon
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Peter Taggart
- University College London, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
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Lampert R. Behavioral influences on cardiac arrhythmias. Trends Cardiovasc Med 2015; 26:68-77. [PMID: 25983071 DOI: 10.1016/j.tcm.2015.04.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 04/12/2015] [Accepted: 04/13/2015] [Indexed: 01/16/2023]
Abstract
Stress can trigger both ventricular and atrial arrhythmias, as evidenced by epidemiological, clinical, and laboratory studies, through its impact on autonomic activity. Chronic stress also increases vulnerability to arrhythmias. Novel therapies aimed at decreasing the psychological and physiological response to stress may decrease arrhythmia frequency and improve quality of life.
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Affiliation(s)
- Rachel Lampert
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT.
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Peacock J, Whang W. Psychological distress and arrhythmia: risk prediction and potential modifiers. Prog Cardiovasc Dis 2013; 55:582-9. [PMID: 23621968 DOI: 10.1016/j.pcad.2013.03.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The connection between the heart and the brain has long been anecdotally recognized but has systematically been studied only relatively recently. Cardiac arrhythmias, especially ventricular arrhythmias that can lead to sudden cardiac death, remain a major public health concern and there is mounting evidence that psychological distress plays a critical role both as a predictor of high-risk cardiac substrate and as an inciting trigger. The transient, unpredictable nature of emotions and cardiac arrhythmias has made their study challenging, but evolving technologies in monitoring and imaging along with larger epidemiological data sets have encouraged more sophisticated studies examining this relationship. Here we review the research on psychological distress including anger, depression and anxiety on cardiac arrhythmias, insights into proposed mechanisms, and potential avenues for future research.
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Affiliation(s)
- James Peacock
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
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Burg MM, Edmondson D, Shimbo D, Shaffer J, Kronish IM, Whang W, Alcántara C, Schwartz JE, Muntner P, Davidson KW. The 'perfect storm' and acute coronary syndrome onset: do psychosocial factors play a role? Prog Cardiovasc Dis 2013; 55:601-10. [PMID: 23621970 DOI: 10.1016/j.pcad.2013.03.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The revolution in cardiac care over the past two decades, characterized by emergent revascularization, drug eluting stents, anti-platelet medications, and advanced imaging has had little impact on overall ACS recurrence, or ACS prevention. The "Perfect Storm" refers to a confluence of events and processes, including atherosclerotic plaque, coronary flow dynamics, hemostatic and fibrinolytic function, metabolic and inflammatory conditions, neurohormonal dysregulation, and environmental events that give rise to, and result in an ACS event. In this article we illustrate the limits of the traditional main effect research model, giving a brief description of the current state of knowledge regarding the development of atherosclerotic plaque and the rupturing of these plaques that defines an ACS event. We then apply the Perfect Storm conceptualization to describe a program of research concerning a psychosocial vulnerability factor that contributes to increased risk of recurrent ACS and early mortality, and that has defied our efforts to identify underlying pathophysiology and successfully mount efforts to fully mitigate this risk.
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Affiliation(s)
- Matthew M Burg
- Department of Medicine, Center for Cardiovascular Behavioral Health, Columbia University, New York, NY 10032, USA
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Abstract
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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Taggart P, Boyett MR, Logantha SJRJ, Lambiase PD. Anger, emotion, and arrhythmias: from brain to heart. Front Physiol 2011; 2:67. [PMID: 22022314 PMCID: PMC3196868 DOI: 10.3389/fphys.2011.00067] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 09/14/2011] [Indexed: 01/01/2023] Open
Abstract
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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Affiliation(s)
- Peter Taggart
- Neurocardiology Research Unit, Department of Medicine, University College LondonLondon, UK
| | - Mark R. Boyett
- Cardiovascular Medicine, University of ManchesterManchester, UK
| | | | - Pier D. Lambiase
- Department of Cardiology, University College London HospitalsLondon, UK
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Abstract
PURPOSE OF REVIEW Although anecdotal evidence has long suggested links between emotion and ventricular arrhythmia, more recent studies have prospectively demonstrated the arrhythmogenic effects of anger, as well as mechanisms underlying these effects. RECENT FINDINGS Epidemiological studies reveal that psychological stress increases sudden death, as well as arrhythmias, in patients with implantable cardioverter-defibrillators, in populations during emotionally devastating disasters such as earthquake or war. Diary-based studies confirm that anger and other negative emotions can trigger potentially lethal ventricular arrhythmias. Anger alters electrophysiological properties of the myocardium, including T-wave alternans, a measure of heterogeneity of repolarization, suggesting one mechanistic link between emotion and arrhythmia. Pilot studies of behavioral interventions have shown promise in decreasing arrhythmias in patients with implantable cardioverter-defibrillators. SUMMARY Anger and other strong emotions can trigger polymorphic, potentially life-threatening ventricular arrhythmias in vulnerable patients. Through autonomic changes including increased sympathetic activity and vagal withdrawal, anger leads to increases in heterogeneity of repolarization as measured by T-wave alternans, known to be associated with arrhythmogenesis, as well as increasing inducibility of arrhythmia. Further delineation of mechanisms linking anger and arrhythmia, and of approaches to decrease the detrimental effects of anger and other negative emotions on arrhythmogenesis, are important areas of future investigation.
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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. Psychosom Med 2010; 72:172-7. [PMID: 20028832 PMCID: PMC2826193 DOI: 10.1097/psy.0b013e3181c932d4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To 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 last 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), antitachycardia pacing 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 laboratory 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 Reducing Vulnerability to ICD Shock-Treated Ventricular Arrhythmias (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.
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Lathers CM, Schraeder PL, Bungo MW. The mystery of sudden death: mechanisms for risks. Epilepsy Behav 2008; 12:3-24. [PMID: 18086454 DOI: 10.1016/j.yebeh.2007.09.016] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2007] [Revised: 09/19/2007] [Accepted: 09/19/2007] [Indexed: 11/30/2022]
Abstract
This review addresses the possible overlapping mechanisms that may apply to the risk of sudden unexpected death occurring in epilepsy and in cardiac disease. It explores the interaction between the central and peripheral autonomic nervous systems and the cardiopulmonary systems. Included is a discussion of the potential interactive role of genetically determined subtle cardiac risk factors for arrhythmias with a predisposition for seizure-related cardiac arrhythmias. We address the possible mechanisms that are operant in producing both epileptogenic and cardiogenic arrhythmias. Finally, we speculate about potential preventive measures to minimize the risk of both sudden unexpected death in epilepsy and sudden cardiac death.
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Affiliation(s)
- Claire M Lathers
- Center for Veterinary Medicine, U.S. Food and Drug Administration, Rockville, MD 20855, USA.
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19
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Schalij MJ, van Erven L. Anger and arrhythmias. Heart Rhythm 2007; 4:274-6. [PMID: 17341386 DOI: 10.1016/j.hrthm.2006.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Indexed: 11/22/2022]
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