Anger-Induced T-Wave Alternans Predicts Future Ventricular Arrhythmias in Patients With Implantable Cardioverter-Defibrillators

Rachel Lampert; Vladimir Shusterman; Matthew Burg; Craig McPherson; William Batsford; Anna Goldberg; Robert Soufer

doi:10.1016/j.jacc.2008.10.053

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Anger-Induced T-Wave Alternans Predicts Future Ventricular Arrhythmias in Patients With Implantable Cardioverter-Defibrillators

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Anger-Induced T-Wave Alternans Predicts Future Ventricular Arrhythmias in Patients With Implantable Cardioverter-Defibrillators

Rachel Lampert, Vladimir Shusterman, Matthew Burg, Craig McPherson, William Batsford, Anna Goldberg and Robert Soufer

Journal of the American College of Cardiology, Vol.53(9), pp.774-778

03/03/2009

DOI: 10.1016/j.jacc.2008.10.053

PMCID: PMC3979284

PMID: 19245968

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Abstract

This study sought to determine whether T-wave alternans (TWA) induced by anger in a laboratory setting predicts future ventricular arrhythmias in patients with implantable cardioverter-defibrillators (ICDs). Anger can precipitate spontaneous ventricular tachycardia/ventricular fibrillation and induce TWA. Whether anger-induced TWA predicts future arrhythmias is unknown. Sixty-two patients with ICDs underwent ambulatory electrocardiography during a mental stress protocol, 3 months after the ICD was implanted. T-wave alternans was analyzed using time-domain methods. After a ≥1 year follow-up, ICD stored data was reviewed to determine incidence of ICD-terminated ventricular tachycardia/ventricular fibrillation. Patients with ICD-terminated arrhythmias during follow-up (n = 10) had higher TWA induced by anger, 13.2 μV (interquartile range [IQR] 9.3 to 16 μV), compared with those patients without future ventricular arrhythmias, 9.3 μV (IQR 7.5 to 11.5 μV, p < 0.01). Patients in the highest quartile of anger-induced TWA (>11.9 μV, n = 15) were more likely to experience arrhythmias by 1 year than those in the lower quartiles (33% vs. 4%) and during extended follow-up (40% vs. 9%, p < 0.01 for both). In multivariable regression controlling for ejection fraction, prior clinical arrhythmia, and wide QRS, anger-induced TWA remained a significant predictor of arrhythmia, with likelihood in the top quartile 10.8 times that of other patients (95% confidence interval: 1.6 to 113, p < 0.05). Anger-induced TWA predicts future ventricular arrhythmias in patients with ICDs, suggesting that emotion-induced repolarization instability may be 1 mechanism linking stress and sudden death. Whether there is a clinical role for anger-induced TWA testing requires further study.

anger

implantable cardioverter-defibrillator

tachyarrhythmias (ventricular)

Details

Title: Subtitle: Anger-Induced T-Wave Alternans Predicts Future Ventricular Arrhythmias in Patients With Implantable Cardioverter-Defibrillators
Creators: Rachel Lampert - Yale University School of Medicine, New Haven, Connecticut
Vladimir Shusterman - PinMed Inc. and University of Pittsburgh, Cardiovascular Institute, Pittsburgh, Pennsylvania
Matthew Burg - Yale University School of Medicine, New Haven, Connecticut
Craig McPherson - Yale University School of Medicine, New Haven, Connecticut
William Batsford - Yale University School of Medicine, New Haven, Connecticut
Anna Goldberg - PinMed Inc. and University of Pittsburgh, Cardiovascular Institute, Pittsburgh, Pennsylvania
Robert Soufer - Yale University School of Medicine, New Haven, Connecticut
Resource Type: Journal article
Publication Details: Journal of the American College of Cardiology, Vol.53(9), pp.774-778
DOI: 10.1016/j.jacc.2008.10.053
PMID: 19245968
PMCID: PMC3979284
NLM abbreviation: J Am Coll Cardiol
ISSN: 0735-1097
eISSN: 1558-3597
Publisher: Elsevier Inc
Language: English
Date published: 03/03/2009
Academic Unit: Cardiovascular Medicine; Internal Medicine
Record Identifier: 9984094543402771

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