Published Online
on September 9, 2002

A more recent version of this article appeared on October 1, 2002

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Submitted on April 25, 2002
Revised on July 17, 2002
Accepted on July 17, 2002

Emotional and Physical Precipitants of Ventricular Arrhythmia

Rachel Lampert MD, Tammy Joska MS, Matthew M. Burg PhD, William P. Batsford MD, Craig A. McPherson MD, and Diwakar Jain MD^*

From Yale University School of Medicine, New Haven, Conn (R.L., M.M.B., W.P.B., C.A.M.); Dartmouth College, Hanover, NH (T.J.); and Drexel University College of Medicine, Philadelphia, Pa (D.J.).

^* To whom correspondence should be addressed. E-mail: Diwakar.Jain{at}drexel.edu.

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 3 preceded 15% of events compared with 3% of control periods (P<0.04; 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 patients.

Key words: tachyarrhythmia • anger • defibrillators, implantable

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