THE EFFECTS OF PSYCHOSOCIAL STRESS ON VENTRICULAR ARRHYTHMIAS (SUDDEN CARDIAC DEATH, FIBRILLATION, TACHYCARDIA, PROGRAMMED ELECTRICAL STIMULATOR)

Abstract

A major difficulty in relating psychosocial factors to the pathogenesis of life-threatening ventricular arrhythmias has been the inability to measure electrophysiologic parameters directly in humans. If biobehavioral variables contribute to the development of such disturbances in cardiac rhythm, then patients undergoing Programmed Electrical Stimulation (PES) for selection of antiarrhythmic therapy are an ideal population to test out the hypothesis that patients experiencing greater amounts of psychosocial stress are more prone towards arrhythmia induction.;Twenty-nine subjects admitted to Montefiore Hospital and Medical Center were administered a battery of five independent measures of psychosocial stress the night preceeding electrophysiologic study in the catheterization laboratory. Life events, hospital procedure-related stress, and emotional status were quantified and correlated with the electrophysiologic parameters of PES. Both external stressors and internal responses to stress were studied. Multiple logistic regression analyses controlled for a number of demographic and biomedical variables including New York Heart Association functional class, severity of arrhythmia grade during 24-hour monitoring and exercise stress testing, cardiac output, and coronary artery disease.;Results revealed that patients whose symptoms produced greater functional disability and who reported feeling angry and hostile prior to PES tended to be easier to induce (p < .10). Surprisingly, patients who reported experiencing the least hospital stress required greater effort to terminate their arrhythmia (p < .05). Denial of distress can help explain this finding and may indeed be associated with a poorer clinical outcome in arrhythmia patients. While major life events appeared to be clinically relevant, statistical testing did not indicate they were significantly related to PES outcome.;Though the sample was small and the current findings modest, the method employed shows promise for biobehavioral investigation of sudden cardiac death risk. If psychosocial stress is indeed a contributory factor in the development of ventricular arrhythmias, the experimental design initiated by this study may help in determining the selection of potentially life-saving antiarrhythmic therapy.