Author + information
- Received February 29, 2008
- Revision received October 14, 2008
- Accepted October 19, 2008
- Published online March 3, 2009.
- Rachel Lampert, MD, FACC*,* (, )
- Vladimir Shusterman, MD, PhD†,
- Matthew Burg, PhD*,‡,
- Craig McPherson, MD, FACC*,
- William Batsford, MD*,
- Anna Goldberg, BS† and
- Robert Soufer, MD, FACC*,‡
- ↵*Reprint requests and correspondence:
Dr. Rachel Lampert, Yale Cardiology, 333 Cedar Street, FMP 3, New Haven, Connecticut 06520
Objectives This study sought to determine whether T-wave alternans (TWA) induced by anger in a laboratory setting predicts future ventricular arrhythmias in patients with implantable cardioverter-defibrillators (ICDs).
Background Anger can precipitate spontaneous ventricular tachycardia/ventricular fibrillation and induce TWA. Whether anger-induced TWA predicts future arrhythmias is unknown.
Methods Sixty-two patients with ICDs underwent ambulatory electrocardiography during a mental stress protocol, 3 months after the ICD was implanted. T-wave alternans was analyzed using time-domain methods. After a ≥1 year follow-up, ICD stored data was reviewed to determine incidence of ICD-terminated ventricular tachycardia/ventricular fibrillation.
Results Patients with ICD-terminated arrhythmias during follow-up (n = 10) had higher TWA induced by anger, 13.2 μV (interquartile range [IQR] 9.3 to 16 μV), compared with those patients without future ventricular arrhythmias, 9.3 μV (IQR 7.5 to 11.5 μV, p < 0.01). Patients in the highest quartile of anger-induced TWA (>11.9 μV, n = 15) were more likely to experience arrhythmias by 1 year than those in the lower quartiles (33% vs. 4%) and during extended follow-up (40% vs. 9%, p < 0.01 for both). In multivariable regression controlling for ejection fraction, prior clinical arrhythmia, and wide QRS, anger-induced TWA remained a significant predictor of arrhythmia, with likelihood in the top quartile 10.8 times that of other patients (95% confidence interval: 1.6 to 113, p < 0.05).
Conclusions Anger-induced TWA predicts future ventricular arrhythmias in patients with ICDs, suggesting that emotion-induced repolarization instability may be 1 mechanism linking stress and sudden death. Whether there is a clinical role for anger-induced TWA testing requires further study.
PinMed Inc. provided the repolarization analysis software used in this study. Dr. Lampert receives funding from the American Heart Association (Dallas, Texas) Scientist Development Grant (#0030190) and research grants from Boston Scientific, Medtronic, and St. Jude (minimally relevant to current study). Dr. Shusterman receives funding from the American Heart Association Scientist Development Grant (#0030248N) and National Institutes of Health (#1R43HL077116-01); he also has a significant (>5%) ownership interest in PinMed Inc. Dr. Soufer receives funding from the National Institutes of Health (R01# HL59619-01 and HL071116-01), a Yale Institutional Clinical and Translational Science Award Grant (#UL1 RR024139), and the National Center for Research Resources (NCRR/NIH).
- Received February 29, 2008.
- Revision received October 14, 2008.
- Accepted October 19, 2008.
- American College of Cardiology Foundation