Rachel Lampert1, Matthew M Burg2, Larry D Jamner3, James Dziura4, Cynthia Brandt5, Fangyong Li6, Theresa Donovan2, Robert Soufer2. 1. Department of Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven Connecticut. Electronic address: rachel.lampert@yale.edu. 2. Department of Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven Connecticut. 3. Department of Psychological Science, School of Social Ecology, University of California, Irvine, Irvine, California. 4. Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut. 5. Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut; Department of Medicine, VA Connecticut Healthcare System, West Haven, Connecticut. 6. Yale University School of Public Health, Department of Biostatistics, New Haven, Connecticut.
Abstract
BACKGROUND: Anger and stress can trigger episodes of atrial fibrillation (AF) in patients with a history of AF. OBJECTIVE: The purpose of this study was to determine whether β-blockers can protect against emotionally triggered AF. METHODS: In this prospective, controlled, electronic diary-based study of emotions preceding AF, patients with a history of paroxysmal or persistent AF (N = 91) recorded their rhythm on event monitors at the time of AF symptoms and completed a diary entry querying mood states (eg, anger and stress) for the preceding 30 minutes (pre-AF "case period") for 1 year. Also, patients underwent monthly 24-hour Holter monitoring during which they were prompted to complete a diary entry twice per hour. Diaries recorded during sinus rhythm comprise controls. Patients' exposure to each emotion was compared between the pre-AF case period and control periods by using generalized estimating equation modeling, as well as interactions between β-blocker use and emotion tested. RESULTS: Sixty percent were prescribed β-blockers. A total of 163 symptomatic AF episodes (in 34 patients) and 11,563 Holter-confirmed sinus rhythm control periods had associated diary data. Overall, the likelihood of an AF episode was significantly higher during anger or stress. This effect, however, was significantly attenuated in patients on β-blockers (odds ratio 22.5; 95% confidence interval 6.7-75.4, P < .0001 for patients not prescribed β-blockers vs odds ratio 4.0, 95% confidence interval 1.7-9.5, P = .002 for those prescribed β-blockers; P = .02 for the interaction). Exclusion of patients on sotalol did not affect findings. CONCLUSION: Anger or stress can trigger AF, but use of β-blockers greatly attenuates this deleterious physiological response.
BACKGROUND: Anger and stress can trigger episodes of atrial fibrillation (AF) in patients with a history of AF. OBJECTIVE: The purpose of this study was to determine whether β-blockers can protect against emotionally triggered AF. METHODS: In this prospective, controlled, electronic diary-based study of emotions preceding AF, patients with a history of paroxysmal or persistent AF (N = 91) recorded their rhythm on event monitors at the time of AF symptoms and completed a diary entry querying mood states (eg, anger and stress) for the preceding 30 minutes (pre-AF "case period") for 1 year. Also, patients underwent monthly 24-hour Holter monitoring during which they were prompted to complete a diary entry twice per hour. Diaries recorded during sinus rhythm comprise controls. Patients' exposure to each emotion was compared between the pre-AF case period and control periods by using generalized estimating equation modeling, as well as interactions between β-blocker use and emotion tested. RESULTS: Sixty percent were prescribed β-blockers. A total of 163 symptomatic AF episodes (in 34 patients) and 11,563 Holter-confirmed sinus rhythm control periods had associated diary data. Overall, the likelihood of an AF episode was significantly higher during anger or stress. This effect, however, was significantly attenuated in patients on β-blockers (odds ratio 22.5; 95% confidence interval 6.7-75.4, P < .0001 for patients not prescribed β-blockers vs odds ratio 4.0, 95% confidence interval 1.7-9.5, P = .002 for those prescribed β-blockers; P = .02 for the interaction). Exclusion of patients on sotalol did not affect findings. CONCLUSION: Anger or stress can trigger AF, but use of β-blockers greatly attenuates this deleterious physiological response.
Authors: Trudeke Van Noord; Robert G Tieleman; Hans A Bosker; Tsjerk Kingma; Dirk J Van Veldhuisen; Harry J G M Crijns; Isabelle C Van Gelder Journal: Europace Date: 2004-07 Impact factor: 5.214
Authors: Elaine D Eaker; Lisa M Sullivan; Margaret Kelly-Hayes; Ralph B D'Agostino; Emelia J Benjamin Journal: Circulation Date: 2004-03-01 Impact factor: 29.690
Authors: Rachel Lampert; Tammy Joska; Matthew M Burg; William P Batsford; Craig A McPherson; Diwakar Jain Journal: Circulation Date: 2002-10-01 Impact factor: 29.690
Authors: Carlos Blanco; Franklin R Schneier; Andrew Schmidt; Carmen-Rosa Blanco-Jerez; Randall D Marshall; Arturo Sánchez-Lacay; Michael R Liebowitz Journal: Depress Anxiety Date: 2003 Impact factor: 6.505
Authors: Michelle L Dossett; Emma W Needles; Zachary Donahue; Gillian Gadenne; Eric A Macklin; Jeremy N Ruskin; John W Denninger Journal: Heart Rhythm O2 Date: 2021-06-22
Authors: Kristie M Harris; Daniel L Jacoby; Rachel Lampert; Richard J Soucier; Matthew M Burg Journal: Heart Fail Rev Date: 2020-11-20 Impact factor: 4.214