[Clinical significance of stress reactivity for frequency of electric shock discharges in patients with implanted cardioverter-defibrillators].
OBJECTIVE
Recent research indicates that discharges of implanted cardioverter-defibrillators (ICD) are triggered by psychosocial stress. This study examined the presence of patterns of psychophysiological stress reactivity in ICD-patients. Further more potential relationship between factors of stress reactivity and the frequency of implantable cardioverter-defibrillators discharges was investigated.


METHODS
In 46 consecutive patients (38 male, 8 female; age: 26-80 years) with implantable cardioverter-defibrillators the following parameters of physiological reactivity were measured in a standardised experimental stress test: Heart rate, skin conductance, muscle tension and respiratory activity. In a standardised interview anxiety sensitivity, depression, desire for control, stress load, and attitude towards the defibrillator were evaluated and quantified. The relationship between the mentioned parameters were examined with factor analysis to reveal patterns of psychophysiological reactivity. Potential relationship between psychophysiological factors and frequency of shock delivery was verified with linear regression analysis.


RESULTS
Factor analysis revealed four independent psychophysiological traits. The factors were named "Play Dead Reflex", "Heart Phobia", "Negativism" and "Irritability". Linear regression model showed significant correlation between "Play Dead Reflex" and discharge frequency.


CONCLUSIONS
Results confirm the presence of specific psychophysiological stress reaction patterns in ICD-patients. The stress reaction pattern "Play Dead Reflex" could be discussed as a potential risk factor in developing life-threatening tachyarrhythmias leading to an increase in defibrillator discharges in patients with ICD. This hypothesis should be considered in prospective studies and psychosomatic treatment of concerned patients.
Klein
T
T
Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum des Saarlandes. pstkle@uniklinik-saarland.de
Schonecke
O
O
Wollny
H
H
König
J
J
Fries
R
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000503:physiopathology; D017147:Defibrillators, Implantable / Q000523:psychology; D003863:Depression / Q000503:physiopathology; D005163:Factor Analysis, Statistical; D005260:Female; D006339:Heart Rate; D006801:Humans; D007389:Internal-External Control; D007407:Interviews as Topic; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction; D012119:Respiration; D012879:Skin Physiological Phenomena; D013315:Stress, Psychological / Q000503:physiopathology*; D013610:Tachycardia / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology*