Abstract Stress can trigger both ventricular and atrial arrhythmias, as evidenced by epidemiological, clinical, and laboratory studies, through its impact on autonomic activity. Chronic stress also ...increases vulnerability to arrhythmias. Novel therapies aimed at decreasing the psychological and physiological response to stress may decrease arrhythmia frequency and improve quality of life.
Abstract Psychological stress can lead to atrial and ventricular arrhythmias, but the physiological pathways have not been fully elucidated. Signal processing techniques can provide insight into ...electrophysiological mechanisms of stress-induced arrhythmia. T-wave alternans, as well as other ECG measures of heterogeneity of repolarization, increases with emotional and cognitive stress in the laboratory setting, and may also in “real life” settings. In the atrium, stress impacts components of the signal-averaged ECG. These changes suggest mechanisms by which everyday stressors can lead to arrhythmia.
Repeated-measures analysis of variance compared interventions on changes in log-normalized HF HRV, heart rate, and Likert scale scores from baseline to intervention, with a subsequent t test used to ...conduct pairwise comparisons (no correction for multiple comparisons.) Within-group comparisons were performed by a paired t test. ...in hospitalized post-ACS patients, Reiki increased HF HRV and improved emotional state.
Background Clinical trials have demonstrated the benefit of implantable cardioverter-defibrillators (ICDs) for the primary prevention of sudden cardiac death in selected high-risk individuals. ...Because of small numbers of women enrolled in these trials, outcomes for women after hospital discharge have not been well described. We compared procedure-related complications and outcomes after hospital discharge between men and women undergoing single- or dual-chamber ICD implantation for primary prevention. Methods In patients 65 years or older with Medicare fee-for-service coverage, we identified 38,912 initial implants (25% women) who received single- or dual-chamber ICDs for primary prevention between January 2006 and December 2009 in the NCDR and evaluated gender differences in outcomes. Results Women had greater comorbidity and more advanced heart failure (HF) at the time of ICD implantation than did men. Device-related complications, death at 6 months, all-cause readmissions, and HF readmissions at 6 months were significantly more common in women (7.2% vs 4.8%, 6.5% vs 5.6%, 37.2% vs 31.7%, and 14.0% vs 10.0% respectively; P < .001 for all). Women continued to have higher odds of procedural complications (odds ratio OR 1.39, 95% CI 1.26-1.53, P < .001), 6-month all-cause readmission (OR 1.22, 95% CI 1.16-1.28, P < .001), and 6-month HF readmission (OR 1.32, 95% CI 1.23-1.42, P < .001), with a trend toward higher 6-month mortality (OR 1.08, 95% CI 0.98-1.20, P = .123), compared with men, after adjusting for differences in baseline characteristics and device type (single vs dual chamber). Conclusions Among older patients receiving ICDs for primary prevention in clinical practice, women experience worse outcomes than do men. Reasons for gender differences in outcomes are poorly understood and require further investigation.
Background Many traditional risk factors for coronary artery disease (CAD) are associated with altered autonomic function. Inflammation may provide a link between risk factors, autonomic dysfunction, ...and CAD. We examined the association between heart rate variability (HRV), a measure of autonomic function, and inflammation, measured by C-reactive protein (CRP) and interleukin-6 (IL-6). Methods We examined 264 middle-aged male twins free of symptomatic CAD. All underwent ambulatory electrocardiogram monitoring and 24-hour ultra low, very low, low, and high-frequency power were calculated using power spectral analysis. C-reactive protein and IL-6 were measured, and risk factors including age, smoking, hypertension, lipids, diabetes, body mass index (BMI), depression, and physical activity were assessed. Results Physical activity, BMI, high-density lipoprotein cholesterol, smoking, depression, and hypertension were directly associated with CRP and IL-6 and inversely associated with one or more HRV variables. There was a graded inverse relationship between all HRV parameters (except high frequency) and CRP and IL-6. After adjustment for age, BMI, activity, high-density lipoprotein, smoking, hypertension, depression, and diabetes, ultra low frequency and very low frequency remained significant predictors of CRP ( P < .01). Conclusions C-reactive protein is associated with decreased HRV, even after controlling for traditional CAD risk factors. Autonomic dysregulation leading to inflammation may represent one pathway through which traditional risk factors promote development of CAD.
...sensitivity analyses found the associations were robust even in the setting of nonrandom noncompliance. Because patients were not monitored continuously, the possibility that asymptomatic AF ...started earlier, leading to negative emotion, and then became symptomatic cannot be excluded. ...negative emotions including anger, anxiety, sadness, and stress trigger symptomatic AF, whereas happiness is protective.
The benefit of prophylactic implantation of an implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy (CRT) ICD (CRT-D) in improving mortality in patients with heart ...failure has been firmly established by multiple randomized controlled trials (RCT) (1-4). (9) used patient-level data to compare mortality between ICD recipients in the NCDR (National Cardiovascular Data Registry) meeting criteria for MADIT-II (Multicenter Automatic Defibrillator Implantation Trial II) (3) or SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial) (1) and the participants in those trials, looking at both ICD recipients and those randomized to standard-of-care medical therapy.
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