Cardiac repolarization instability during psychological stress in patients with ventricular arrhythmias

Saddam S Abisse; Rachel Lampert; Matthew Burg; Robert Soufer; Vladimir Shusterman

doi:10.1016/j.jelectrocard.2011.07.019

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Cardiac repolarization instability during psychological stress in patients with ventricular arrhythmias

Journal article

Peer reviewed

Cardiac repolarization instability during psychological stress in patients with ventricular arrhythmias

Saddam S Abisse, Rachel Lampert, Matthew Burg, Robert Soufer and Vladimir Shusterman

Journal of electrocardiology, Vol.44(6), pp.678-683

11/2011

DOI: 10.1016/j.jelectrocard.2011.07.019

PMCID: PMC3200452

PMID: 21920534

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Abstract

Changes in the autonomic nervous system activity are a major trigger of life-threatening ventricular tachyarrhythmias (VTAs). Mental arithmetic, a condition administered in a laboratory setting, can provide insight into the autonomic nervous system activity effects on cardiac physiology. We examined the responses of cardiac repolarization to laboratory-induced psychological stressors in patients with implantable cardioverter-defibrillators (ICDs) with the objective of identifying the indices that differentiate patients with and without subsequent VTA in follow-up. Continuous electrocardiographic signals were recorded using 3 standard bipolar (Holter) leads in 56 patients (age, 63.6 ± 11.9; female, 12%; left ventricular ejection fraction, 32.3 ± 11) with ICDs during mental arithmetic. The patients were separated into those with subsequent VTA during 3 to 4 years of follow-up (group 1: n = 9) and those without VTA (group 2: n = 47). Changes in repolarization (QT interval, mean T wave amplitude [Tamp], and T wave area) were analyzed during 5 minutes at baseline, stress, and recovery. The temporal instability of Tamp and T wave area was examined using the range (Δ) and variance (σ2) of beat-to-beat variations of the corresponding parameters. There were no significant differences in heart rate between the 2 groups at baseline (61 vs 63 beats per minute, P = .97), stress (64 vs 65 beats per minute, P = .40), and recovery (62 vs 61 beats per minute, P = .88). However, during mental stress and poststress recovery, ΔTamp was almost 2-fold greater in group 1 compared with group 2 (111 [57-203] vs 68 [44-94] μV, P = .04, respectively). Changes in QT intervals were also greater in group 1 compared with group 2 (P = .02). Among patients with ICDs, changes of Tamp after psychological stress were greater in those with subsequent arrhythmic events. This might signal proarrhythmic repolarization response and help identify patients who would benefit the most from ICD implantation and proactive management.

Psychological stress ventricular arrhythmias

Electrocardiographic T wave

Repolarization instability

Details

Title: Subtitle: Cardiac repolarization instability during psychological stress in patients with ventricular arrhythmias
Creators: Saddam S Abisse - Cardiovascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
Rachel Lampert - Yale University School of Medicine, New Haven, CT, USA
Matthew Burg - Yale University School of Medicine, New Haven, CT, USA
Robert Soufer - Yale University School of Medicine, New Haven, CT, USA
Vladimir Shusterman - Cardiovascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
Resource Type: Journal article
Publication Details: Journal of electrocardiology, Vol.44(6), pp.678-683
DOI: 10.1016/j.jelectrocard.2011.07.019
PMID: 21920534
PMCID: PMC3200452
NLM abbreviation: J Electrocardiol
ISSN: 0022-0736
eISSN: 1532-8430
Publisher: Elsevier Inc
Language: English
Date published: 11/2011
Academic Unit: Cardiovascular Medicine; Internal Medicine
Record Identifier: 9984094391802771

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