Abstract 46: The Association between Acute Mental Stress and Changes in Left Atrial Electrophysiology
Background: Acute stress may trigger atrial fibrillation, but the mechanisms are not clear. We hypothesized that acute mental stress results in abnormal atrial remodeling via electrophysiologic effects.
Methods: We examined our hypothesis in 168 patients (mean age=63±8.7 years; 74% men; 65% Caucasian) with stable coronary heart disease who underwent mental (speech task) stress testing. PTFV1 duration (ms) times the value of the depth (μV) of the downward deflection (terminal portion) of the median P-wave in lead V1, and was automatically measured on digital electrocardiograms (ECG) at rest, stress, recovery. Electrocardiographic left atrial abnormality was defined as P-wave terminal force in lead V1 (PTFV1) ≤ -4000 μV*ms. The mean values of PTFV1 during stress and recovery were compared with rest. Additionally, the percentage of participants who had left atrial abnormality during stress and recovery was compared with those at rest.
Results: The mean PTFV1 at rest was -2857±2459 μV*ms. There were 51 (30%) participants who had baseline left atrial abnormality. Compared with rest, PTFV1 became more negative with stress [mean change=-474, 95%CI=(-103, -845); p=0.013] and during recovery [mean change=-420, 95%CI=(-79, -761); p=0.016]. A larger percentage of participants showed left atrial abnormality during stress (n=63, 38%) and recovery (n=67, 40%) compared with rest. Similar changes in PTFV1 with stress [mean change=-833, 95%CI=(-372, -1295); p<0.001] and recovery [mean change=-796, 95%CI=(-389, -1204); p<0.001] were observed when we excluded those with baseline left atrial abnormality. No differences were noted in the PTFV1 response based on age, gender, race, or hemodynamic response to stress.
Conclusion: Acute mental stress alters left atrial electrophysiology, as measured by PTFV1, suggesting that stressful situations promote adverse atrial remodeling. This possibly explains the poor cardiovascular outcomes associated with acute mental stress that are triggered by left atrial abnormalities such as atrial arrhythmias and stroke.
Author Disclosures: W.T. O’Neal: None. Z. Almuwaqqat: None. M. Hammadah: None. M.M. Gafeer: None. N. Abdelhadi: None. K. Wilmot: None. I. Al Mheid: None. R. Ramadan: None. J.D. Bremmer: None. M. Kutner: None. E.Z. Soliman: None. A.J. Shah: None. A.A. Quyyumi: None. V. Vaccarino: None.
- © 2017 by American Heart Association, Inc.