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T-wave alternans induced by anger predict tachycardia
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T-wave alternans generated during episodes of anger can be predictors of ventricular tachycardia and ventricular fibrillation in patients with implantable cardioverter defibrillators, study results suggested.
Researchers enrolled 62 patients with CAD in the study. Patients underwent ambulatory electroangiography during a laboratory mental stress protocol at three months following ICD implantation. Patients were separated into quartiles, with the top quartile having the highest levels of anger-induced T-wave alternans (>11.9 µV, n=15).
According to the study results, patients with higher T-wave alternans induced by anger were more likely to experience ICD-terminated ventricular tachycardia/ventricular fibrillation at one year compared with patients in the lower quartiles (33% vs. 4%, P<.01) and during extended follow-up (40% vs. 9%, P<.01). When controlling for follow-up length, patients in the top quartile were 11 times (95% CI, 2-98) more likely to experience ICD-terminated ventricular tachycardia/ventricular fibrillation compared with the other patients. Anger-induced T-wave alternans also remained a predictor of ICD-terminated ventricular tachycardia/ventricular fibrillation following a multivariate analysis (P<.05).
“Anger-induced T-wave alternans predicts future ventricular tachycardia/ventricular fibrillation in patients with ICDs, suggesting that emotion-induced repolarization instability may be one mechanism linking stress and sudden death,” the researchers concluded. “Whether there is a clinical role for anger-induced T-wave alternan testing requires further study.”
Lampert R. J Am Coll Cardiol. 2009;53:774-778.