Mental stress increased the rate of induced ventricular tachycardia and made termination more difficult, with 4 of 10 patients requiring a shock during stress (P=0.03).
Observational (n=18)
Does mental stress alter the induction, rate, or termination of ventricular arrhythmias in patients with ICDs and VT?
Mental stress alters VT cycle length and makes termination more difficult without evidence of ischemia, suggesting a mechanism by which psychological stress may facilitate lethal ventricular arrhythmias.
p-value: p=0.03
BACKGROUND: The incidence of sudden cardiac death increases in populations who experience disasters such as earthquakes. The physiological link between psychological stress and sudden death is unknown; one mechanism may be the direct effects of sympathetic arousal on arrhythmias. To determine whether mental stress alters the induction, rate, or termination of ventricular arrhythmias, we performed noninvasive programmed stimulation (NIPS) in patients with defibrillators and ventricular tachycardia (VT), which is known to be inducible and terminated by antitachycardia pacing, at rest and during varying states of mental arousal. METHODS AND RESULTS: Eighteen patients underwent NIPS in the resting-awake state (nonsedated). Ten underwent repeat testing during mental stress (mental arithmetic and anger recall). Induced VT was faster in 5 patients (P=0.03). VT became more difficult to terminate in 5 patients during mental stress; 4 required a shock (P=0.03). There was no change in ease of induction with mental stress. There was no evidence of ischemia on ECG or continuous ejection fraction monitoring. Eight patients received a shock in the resting-awake state and did not perform mental stress. Four underwent repeat NIPS after sedation; 3 then had induced VT terminated with antitachycardia pacing. All patients with an increase in norepinephrine of >50% had alterations in VT that required shock for termination (P<0.01). CONCLUSIONS: Mental stress alters VT cycle length and termination without evidence of ischemia. This suggests that mental stress may lead to sudden death through the facilitation of lethal ventricular arrhythmias.
Lampert et al. (Tue,) conducted a observational in Implantable cardioverter-defibrillators and ventricular tachycardia (n=18). Mental stress (mental arithmetic and anger recall) vs. Resting-awake state was evaluated on Induction, rate, or termination of ventricular arrhythmias (p=0.03). Mental stress increased the rate of induced ventricular tachycardia and made termination more difficult, with 4 of 10 patients requiring a shock during stress (P=0.03).
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