The anger-insula-body link in heart arrhythmias

Anger is a well-known risk factor in cardiovascular diseases (CVDs) since it triggers a sympathetic hyperactivity of peripheral autonomic nervous system (ANS). As our previous findings showed, facing an angry situation instead of a joyful one elicits in healthy participants an affective engagement that involved mainly the insular reactivity and its connectivity. On the other hand, stimulating the insula, the key neural hub of the cardiovascular brain, can induce cardiac arrhythmias. Unfortunately, still little is known about the interplay between the anger and the insula as the underlying emotional-brain-body link that can trigger or precipitate a series of neurogenic cardiac events in CVDs patients. To address this question, we employed a multimodal method combining neuroimaging, behavioral and blood data to gain a more complete picture of the insula activity and its connectivity in patients with different types of heart arrhythmias. The present findings show a greater generalized involvement of the bilateral posterior insulae in the patients group both when facing angry context and squeezing the handgrip device, suggesting an automatic engagement of the sympathetic nervous system/SNS. Moreover, the bilateral insulae were functionally coupled with the bilateral lateral ventricles selectively under angry conditions, suggesting an insular role in glymphatic dysfunction and CSF dynamics due to the neurovascular coupling. Clearly, understanding this anger-insula-heart link may factually contribute to lower the probability of adverse cardiac outcomes in orienting the necessary treatment of the person, taking into account the emotion-related cardiovascular pathologies and the psychological health.