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Psychological Traits and Emotion-Triggering of ICD Shock-Terminated Arrhythmias

From the From VA Connecticut Healthcare System, West Haven Campus, West Haven, CT (M.M.B.), Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.M.B., R.L., W.B.), Division of General Medicine, Columbia University School of Medicine, New York, NY (M.M.B.), Dartmouth College, Hanover, NH (T.J.), and Drexel University College of Medicine, Philadelphia, PA (D.J.).

Address correspondence and reprint requests to Matthew M. Burg, PhD, Behavioral Cardiovascular Health and Hypertension, Columbia University School of Medicine, 622 West 168 Street, PH 9–941, New York, NY 10032. E-mail: mb2358{at}columbia.edu

OBJECTIVE: We have previously reported on the triggering of arrhythmia and hence, implanted cardioverter-defibrillators (ICD) shock by strong emotion. The purpose of the present study was to examine whether concordant psychological traits distinguish patients who experience emotion-triggered ICD shock.

METHODS: Two hundred forty ICD patients completed the Speilberger Trait Anxiety and Anger Inventories and Anger Expression Scale, and the abridged Cook-Medley Hostility Scale approximately 2 months after ICD implantation. Patients were also given a structured diary to record mood states retrospectively for the period 0 to 15 minutes preceding ICD shock and for a period corresponding to the same time of day 1 week later. Patients who reported emotion-triggered ICD shock were compared on concordant psychological measures to patients who did not.

RESULTS: Patients who reported at least moderate anger in the 0 to 15 minutes before ICD shock scored significantly higher on Speilberger Trait Anger (24.18 ± 3.97 vs. 17.04 ± 2.17, p < .0001), and Cook-Medley Aggressive Responding (5.76 ± 0.75 vs. 3.96 ± 1.30, p < .0001) and Hostile Affect (3.59 ± 0.80 vs. 2.04 ± 1.02, p < .0001), and lower on Speilberger Anger Control (7.94 ± 1.43 vs. 10.64 ± 1.19, p < .001) than those who did not. In multivariate analysis, only Trait Anger remained a significant predictor of anger-triggered shock (² = 7.10, p < .008). Patients who reported at least moderate anxiety in the 0 to 15 minutes before ICD shock scored significantly higher on Speilberger Anxiety (22.43 ± 1.65 vs. 19.96 ± 1.71, p < .0001) than those who did not.

CONCLUSION: Stable psychological factors are associated with risk for ICD-shock triggered by concordant strong emotion.

Key Words: ICD, • emotion, • arrhythmia.

Abbreviations: ICD = implantable cardioverter-defibrillator;; VT = ventricular tachycardia;; VF = ventricular fibrillation;; CAD = coronary artery disease;; CHD = coronary heart disease.

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