Abstract 1036: Impact Of Emotions On Triggering Of Atrial Fibrillation
Small case-series suggest the possibility of “adrenergically-mediated” atrial fibrillation (AF) in humans, and pharmacological autonomic manipulations can alter atrial electrophysiology. Whether AF can be triggered by emotional arousal is unknown. In this prospective, controlled, electronic-diary-based study of emotions preceding AF, patients with a history of paroxysmal or persistent AF, (N=75, mean age 58 years, 60% male, 60% taking beta-blocking medications) recorded their rhythm on event-monitor at the time of AF symptoms, and completed a diary entry querying mood states for the preceding 30 minutes (pre-AF “case period”) over a one-year follow-up. Also, patients underwent monthly 24-hour holter-monitoring, and were prompted by the diary to complete an entry twice per hour. Diaries recorded during sinus comprise the controls. Further, patients completed a diary each night. Patients’ exposure to each emotion was compared between the pre-AF case period and control periods using GEE modeling. Similarly, emotion on a nightly diary preceding AF on the following day was compared to that emotion on other nightly diaries. 119 AF episodes, (in 23 subjects), and 5796 holter-confirmed sinus rhythm control-periods had associated diary data. 95 pre-AF nightly diaries and 9306 control nightly diaries were completed. The likelihood of an AF episode was increased by negative emotions and decreased by happiness whether reported immediately preceding an AF episode, or the night before (table⇓). Impact of emotion was gender-specific: anger increased the odds of subsequent AF for men, worry for women. In stratified analysis, emotion triggered AF only in those not taking beta-blockers (data not shown). Negative emotions can trigger AF, while happiness is protective. Whether interventions aimed at reducing the physiological effects of emotional stress may lessen AF burden requires further study.