Psychological and neuroendocrine correlates of cardiac arrhythmias
Stern, Patricia Jeanne
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The relationship of psychological, neuroendocrine and cardiac risk factors contributing to arrhythmia vulnerability was investigated in patients presenting for electrophysiology studies (EPS). The study was designed to assess whether patients demonstrating arrhythmia vulnerability would also demonstrate high levels of psychological distress and hypercortisol secretion. In addition, the psychological impact of undergoing numerous electrophysiology studies and cardioversions was assessed.;Sixty-nine patients admitted for electrophysiology (EPS) testing were recruited to participate in the study. The Gottschalk-Gleser Content Analysis (GGCA) method was used to assess patient levels of anxiety, hostility and depression 24 hours prior to their initial EPS test, and again at hospital discharge following the completion of all EPS tests. Measures of plasma cortisol and arrhythmia vulnerability were obtained during the patient's initial EPS test. Multivariate analyses controlling for New York Heart Association functional class, previous history of MI and other physiological variables revealed the following results.;The study demonstrated that EPS patients with high levels of mutilation anxiety had correspondingly elevated levels of endogenous cortisol. Contrary to our initial hypothesis, separation anxiety and hostility directed inward were each inversely related to cortisol level. Possible mediating variables contributing to this relationship were (1) transmission of family members psychological distress, and (2) the use of denial as a cognitive coping strategy.;In general, neither psychological distress nor hypercortisolaemia, emerged as significant predictors of arrhythmia vulnerability. However, moderately higher cortisol levels were found in ventricular tachycardia (VT) patients as compared to non-VT control patients. Measures of patients' Pre-EPS total anxiety and Post-EPS shame anxiety independently emerged as significant predictors of 18 month follow-up mortality status.;Participation in greater numbers of EPS tests was found to be associated with higher levels of death anxiety and guilt anxiety; increased exposure to cardioversion was associated with elevated levels of self-reported anxiety. In spite of the study's modest statistical power, trends emerged indicating a complex interaction between psychological and neuroendocrine factors contributing to arrhythmia vulnerability. The results are discussed in terms of implications for future studies and psychological interventions for EPS patients.