Electrophysiologic characteristics of anger-triggered arrhythmias.
BACKGROUND
Anger can precipitate ventricular arrhythmias in patients with implantable cardioverter-defibrillators (ICDs). Determining electrophysiologic characteristics of anger-triggered arrhythmias may help elucidate the mechanisms that link emotion and arrhythmia.


OBJECTIVE
We sought to compare the morphology and initiation pattern between ventricular arrhythmias that are triggered by anger and those that are not.


METHODS
At the time of shock, patients with ICDs recorded levels of defined mood states preceding the shock in a diary. Stored intracardiac electrograms (EGMs) were retrieved and analyzed in relation to corresponding mood states. The EGMs from 56 appropriate shocks in 24 patients (18 male, mean age 66 years, 74% with coronary artery disease) were reviewed and analyzed for morphology, mechanism of initiation (sudden onset vs. premature ventricular contraction [PVC]), pause dependence, and other characteristics.


RESULTS
Polymorphic ventricular tachycardia was more common in anger-triggered events, occurring in three (37.5%) of eight anger-triggered events compared with five (10.4%) of 48 of non-anger-triggered events (P <.05). Anger-triggered events were more likely to have PVC initiation, occurring in eight (100%) of eight, compared with 30 (68%) of 44 of non-anger-triggered events (P <.05). More anger-triggered events were pause dependent: five (62.5%) of eight versus seven (15%) of 37 non-anger-related events (P <.01). No difference in response to initial therapy was observed in anger-triggered arrhythmias.


CONCLUSIONS
Ventricular arrhythmias occurring in the setting of anger are more likely pause dependent and polymorphic. This suggests that in predisposed populations anger may create an arrhythmogenic substrate susceptible to more disorganized rhythms, a possible mechanism linking emotion and sudden death.
Stopper
Matthew
M
Yale University School of Medicine, New Haven, Connecticut 06520, USA.
Joska
Tammy
T
Burg
Matthew M
MM
Batsford
William P
WP
McPherson
Craig A
CA
Jain
Diwakar
D
Lampert
Rachel
R
D000339:Affect; D000368:Aged; D000786:Anger; D001145:Arrhythmias, Cardiac / Q000503:physiopathology* / Q000523:psychology* / Q000628:therapy; D018592:Cross-Over Studies; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D012008:Recurrence; D012107:Research Design; D017180:Tachycardia, Ventricular / Q000503:physiopathology; D014693:Ventricular Fibrillation / Q000503:physiopathology; D018879:Ventricular Premature Complexes / Q000503:physiopathology