Abstract 3873: Episodes of Anger Trigger Ventricular Arrhythmias in Patients with Implantable Cardioverter Defibrillators
Background: Acute episodes of anger increase T-wave alternans in patients with CHD who have implantable cardioverter defibrillators (ICDs); but whether anger can trigger spontaneous ventricular arrhythmias remains uncertain.
Methods: We utilized a prospective nested case-crossover design to address the hypothesis that acute episodes of anger trigger shocks for ventricular tachycardia or ventricular fibrillation (VT/VF) among 1188 ICD patients enrolled in the multi-center Triggers of Ventricular Arrhythmia Study. Participants were interviewed regarding their usual frequency of anger at entry into the study and at follow-up intervals. After ICD discharge, participants were interviewed regarding exposure to anger prior to ICD discharge, and stored electrograms from these discharges were reviewed by electrophysiologists to identify instances of sustained VT or VF.
Results: Over a median follow-up of 541 days (interquartile range, 359 to 884), there were 271 ICD discharges with matching interview data, of which 199 were due to VT/VF in 125 patients. In the hour prior to ICD discharge, 15 (7.5%) of the shocks for VT/VF were preceded by at least moderate levels of anger. Utilizing the case-crossover method, the risk of ICD discharge for VT/VF was significantly elevated within one hour of exposure to moderate levels of anger as compared to the risk during periods of no anger (RR=3.2; 95% CI, 1.8–5.7). Being very angry or furious in the hour prior to ICD discharge was associated with an even greater risk (RR=16.7; 95% CI, 8.12–34.5). Patients with LVEF less than 30%, recent implant within 6 months, or a history of prior ICD discharge were at significantly greater risk of VT/VF in association with anger (Table⇓).
Conclusion: In this prospective cohort of ICD patients, acute episodes of anger were associated with transiently increased risks of VT/VF resulting in ICD discharge, particularly among those with systolic dysfunction or recent ICD implant or previous shocks.