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Psychosomatic Medicine 66:898-902 (2004)
© 2004 American Psychosomatic Society

ORIGINAL ARTICLES

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

Matthew M. Burg, PhD, Rachel Lampert, MD, Tammy Joska, MA, William Batsford, MD and Diwakar Jain, MD

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


   ABSTRACT
TOP
 ABSTRACT
INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
 NOTES
 REFERENCES
 
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 ({chi}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.


   INTRODUCTION
TOP
 ABSTRACT
 INTRODUCTION
METHODS
 RESULTS
 DISCUSSION
 NOTES
 REFERENCES
 
Emotional triggering of sudden cardiac death has been described in both anecdotal reports and epidemiological studies. For example, case studies describe the experience of acute grief, fear, or anger as precipitants of sudden death (1,2), and both prospective and retrospective studies demonstrate increased rates of sudden death during such emotionally charged conditions as earthquake and war (3,4).

Other evidence suggests that emotional stress can provoke arrhythmic events, some of which can be potentially fatal. Ventricular tachycardia (VT) is more frequent on Mondays in patients with implanted cardioverter-defibrillators (ICD) (5), while atrial and ventricular ectopy and nonsustained arrhythmias are seen in on-call medical interns (6) and animals exposed to socially threatening environments (7). In addition, psychological and emotional stress invoked under controlled laboratory conditions can induce electrical instability, as demonstrated by T-wave alternans (8) and VT (9). Animal studies also demonstrate that laboratory stress can make termination of potentially fatal arrhythmias more difficult (10). The greater frequency of VT in the morning hours (11) correlates with the morning peak in catecholamines (12) and lowest vagal tone (13), lending further support to a role for stress and sympathetic arousal in arrhythmia and sudden death.

A range of psychological factors, most notably anger and hostility, has been found to impart increased risk for acute cardiac events (cf 14). We and others have found that anger and hostility, assessed as stable psychological traits, are associated with the provocation of ischemia during the performance of stressful tasks (15), and during routine daily activities (16). We have also found in cross-sectional analyses that the psychological traits of anger and anxiety are related to total ICD therapy for sustained arrhythmias, controlling for the amount of time the patient has had the ICD (17).

More recently, and consistent with the literature on triggering of nonfatal myocardial infarction (18), we have reported that the experience of moderate to strong anger or anxiety can trigger potentially fatal arrhythmias and hence, shock in patients with ICD (19). The purpose of the present study was to determine whether patients who experienced emotion-triggered arrhythmias requiring ICD-shock for termination secondary to moderately strong anger or anxiety were distinguished from patients without emotion-triggered arrhythmias by psychological traits concordant with the arrhythmia-triggering emotion: to examine whether "trait" and "state" match for emotionally triggered ventricular arrhythmias.


   METHODS
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
RESULTS
 DISCUSSION
 NOTES
 REFERENCES
 
Patient Sample
This is a further examination of a sample described previously (19). Briefly, the total sample comprised 240 patients who had received ICDs for standard indications from 1996 to 1999 and were subsequently followed for ICD-related care at the Yale New Haven Hospital. Exclusion criteria included significant comorbid psychopathology (eg, psychotic illness, dementia, and substance dependence). Patients were approached regarding study participation at the time of their first follow-up appointment after implantation of their ICD (2 months). The local Human Investigations Subcommittee approved the study.

Psychological Measures
At the time of enrollment, patients completed a standardized questionnaire battery comprising multiple measures of anger, hostility, and anxiety. These included the Speilberger Trait Personality Inventory (20), from which scores for trait anger and anxiety were obtained, the Speilberger Anger Expression Scale (21), from which scores for anger control were obtained, and the abridged Cook-Medley Hostility Scale (22), from which scores for hostile affect and aggressive responding were obtained.

Structured Diary
Patients were given a structured diary, described and validated in previous studies of triggers of cardiac events (cf 16,19) to record their activities and mood states. Briefly, the diary provides a 5-point Likert scale to rate emotion intensity for anger, anxiety, worry, sadness, happiness, and feelings of challenge, interest, and control. The diary also included a checklist of specific activities, classified into validated levels of physical intensity. Patients were oriented to the use of the diary and instructed to complete a diary page for two predefined hazard periods whenever they experienced an ICD shock: the period 0 to 15 minutes preceding shock, and the period 15 to 120 minutes preceding shock. Patients were also instructed to call the study coordinator whenever they experienced an ICD shock, and were called back by the nurse to review diary responses and provide guidance as needed. Lastly, they were instructed to complete a diary page 1 week later for a period corresponding to the same time of day; this diary entry served as a control. The study nurse contacted the patient on that day as a reminder. For the current report, we describe results associated with the period 0 to 15 minutes before shock because we have previously found this to be the more important period for triggering of potentially fatal arrhythmia and hence, shock by strong emotion (19).

Study Design and Statistical Analyses
Case-crossover methods (23), used previously in research on triggers of cardiac events (18), were used for analyzing entries from diaries. In this approach, "case" information gathered at the time of interest (eg, ICD shock) is compared with "control" information gathered later, at a comparable time (eg, same day/time, 1 week later). The heart rhythm precipitating ICD shock was determined by review of data stored on the ICD, and only events confirmed to be VT or ventricular fibrillation were included in analysis. Any arrhythmia requiring more than one shock for termination was counted as a single shock event. Having previously demonstrated an arrhythmia-triggering effect for moderate levels of experienced anger and anxiety (19), we sought to determine whether stable psychological characteristics associated with these emotional states increased risk for such triggering. To do this, we compared those patients who reported emotion-triggered shocks to those who did not. For both anger and anxiety, t test was utilized, with logistic regression following in the case of anger due to the multiple trait-based measures of anger employed.


   RESULTS
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
DISCUSSION
 NOTES
 REFERENCES
 
As reported previously (19), a total of 187 shock events were recorded by 61 patients over the 3-year study period. Of these, 80 shock reports were excluded from analysis, because they were either "phantoms" (eg, no shock was administered, n = 29), inappropriate shocks caused by supraventricular rhythms (eg, atrial fibrillation, sinus tachycardia, n = 19) or ICD malfunction (n = 8), had no accompanying stored electrocardiogram (n = 8), or had no accompanying control period data (n = 17). The remaining 107 shocks occurred in 42 patients. These 42 patients had a mean age of 65 ± 7, and 33 (78%) had a diagnosis of coronary artery disease (CAD); 33 (79%) were male. At least moderate anger was reported on diary by 17 patients preceding at least 1 shock and was associated with 15% of shock-period diary entries compared with 4% of control-period diary entries (OR, 5.33; 95% CI, 1.44–22.80, p < .01). At least moderate anxiety was reported on diary by 14 patients preceding 1 shock and was associated with 19% of shock-period diary entries compared with 7% of control-period diary entries (OR, 2.86; 95% CI, 1.25–12.16, p < .02). There were no differences in levels of other mood states between case and control periods (19). Medication profile was remarkable for 46% on ß-blocker, 37% on amiodarone, 20% on sotalol, 59% on antiarrhythmic, and 61% on polypharmacy, with no differences in medication profiles between those patients reporting emotion-triggered arrhythmia and those not.

Anger
The 17 patients who reported at least moderate anger in the 0 to 15 minutes before ICD shock were compared with the remaining 25 patients who did not report anger in the 0 to 15 minutes before shock on the trait anger related questionnaire measures (see Table 1). Those who reported anger-triggered episodes scored significantly higher on the Speilberger Trait Anger (24.18 ± 3.97 vs. 17.04 ± 2.17, p < .0001), and the Cook-Medley-based 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) measures, and lower on the Speilberger Anger Control (7.94 ± 1.43 vs. 10.64 ± 1.19, p < .001) measure. In multivariate analysis, only Trait Anger remained a significant predictor of anger-triggered arrhythmia ({chi}2 = 7.10, p < .008).


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  		TABLE 1. Univariate Effects and Multivariate Models for Emotion-Triggered ICD Shock
 
Anxiety
The 14 patients who reported at least moderate anxiety in the 0 to 15 minutes before ICD shock were compared with the remaining 28 patients who did not report such anxiety in the 0 to 15 minutes before shock on the Speilberger Trait Anxiety measure (Table 1). The patients who reported anxiety-triggered arrhythmia scored significantly higher on this measure (22.43 ± 1.65 vs. 19.96 ± 1.71, p < .0001).


   DISCUSSION
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
NOTES
 REFERENCES
 
In this study, ICD patients who reported a moderate to strong state of anger or anxiety in the minutes preceding shock-treated sustained ventricular arrhythmias—emotion-triggered arrhythmias—were found to demonstrate significantly higher scores on concordant trait measures of anger or anxiety at baseline, as compared with ICD patients who did not suffer emotion-triggered arrhythmias. Elements of the patient’s characteristic and stable (20–22) psychological trait profile therefore predicted both the emotion triggering of arrhythmia, and the valence of the emotional trigger, findings that are consistent with the literature on mental stress ischemia (cf 14,15,24–26) and acute coronary syndromes (cf 27–32). These findings are also consistent with earlier literature on ICD patients that relied on measures that capture emotion as a transient state rather than as a stable psychological characteristic, as accomplished in the current study (33). Of note were the elevations on the Speilberger Trait Anger and Trait Anxiety measures seen in the emotion-triggered groups, which on average were within 1 to 1.5 standard deviations of the mean for the healthy adult population on which the psychometric properties of these scales were established (20,21). In addition, little overlap in scores on these measures between the emotion-triggered and non-emotion-triggered groups was seen. These findings therefore indicate that it should be possible to identify patients at the time of ICD implant who are at risk for emotion-triggered arrhythmias. Toward this end, previous research (cf 34) has reported that individuals scoring in the range of patients who reported emotion-triggered arrhythmia in the current study were distinguished by a frequency of emotion-related episodes of at least several times each week. In the study on which the current report is based (19), the threshold of emotion intensity associated with arrhythmia triggering was ≥3 on a 5 point Likert scale (eg, at the "moderate" level). Hence, clinicians could potentially identify at-risk ICD patients by merely asking them about the frequency and intensity of anger/anxiety experiences.

The ability to identify patients at risk for emotion-triggered arrhythmias has important clinical implications for the quality of life of ICD patients, because the experience of ICD shock has been associated with higher levels of anxiety and depression (17), and reduced quality of life (35), particularly if shock occurs repeatedly during the first year after implantation (36,37). Adjustment issues associated with ICD implantation must therefore become an important focus for clinicians who treat these patients (38,39). The ICD provides a safety net for patients at high risk of sudden cardiac death, and can therefore be seen to provide "a new lease on life" for recipients. If, however, psychological factors increase the likelihood of ICD shock therapy and hence, interfere with full recovery and adjustment, then these psychological factors become an important focus for treatment. The implication is that the likelihood of ICD shock would be reduced if the propensity for becoming angry or anxious when under stress were reduced. Although the current study found stable aspects of these psychological factors to be predictive of emotion-triggered arrhythmia, previous research with CAD populations has demonstrated that, while stable, these traits are amenable to treatment and that successful treatment is associated with reduced risk for transient ischemic events and recurrent myocardial infarction (40,41). A pilot investigation with patients evidencing panic disorder subsequent to frequent ICD-shock has shown promising results (42). Larger clinical trials examining the effect on ICD activity of psychological treatments for either stress generally, or anger and anxiety specifically, are therefore warranted.

The current findings raise important questions as to the mechanisms by which stable psychological traits can influence the occurrence of potentially fatal arrhythmias. It may be that those with higher trait anger or anxiety are more prone to experience frequent correlated emotional states during routine daily activities (43–45). As our previous study has demonstrated, these emotions can precipitate arrhythmia, likely due to associated increases in sympathetic arousal. Alternatively, it may be that chronic, trait-based psychological factors such as anger and anxiety heighten risk of arrhythmia due to chronic influences on sympathetic-parasympathetic balance. Indeed, prior research has demonstrated altered sympathetic-parasympathetic balance in association with chronic factors associated with anger and anxiety (46). Future studies should therefore be directed toward developing a greater understanding of the interaction between trait and state factors in the triggering of arrhythmia, and the pathophysiological mechanisms by which these factors exert their influence.

There are several limitations to the current study. For example, as we noted previously (19), we cannot rule out the possibility of recall bias with regard to the emotions reported by patients in concert with ICD shock, although other negative emotions were not similarly endorsed. We also cannot rule out the possibility that patients who reported extremes of anger or anxiety in the moments before ICD shock did not alter their behavior during the subsequent control period, thereby influencing findings regarding the strength of state emotions as arrhythmia triggers, although this supposition is not supported in the literature (47). The size of the study population was also relatively small, and many episodes of ICD shock were eliminated from analysis. In addition, the current study only examined arrhythmia events of sufficient severity to require shock for termination, since patients are generally not aware of events terminated by antitachycardia pacing. To determine the potential role of psychological state and traits on arrhythmic events that are terminated by antitachycardia pacing, approaches should be considered that provide for more complete capture of emotion states over extended periods of time and during participants’ routine daily activities, as has been described in the literature on transient ischemia (48).

In summary, individuals with high levels of trait anger and anxiety are significantly more likely to suffer ICD-treated ventricular arrhythmias triggered by moderate to strong anger or anxiety than those patients without these concordant psychological traits. Future studies should examine the potential benefits on arrhythmia of treating the identified trait psychological factors of anger and anxiety.


   NOTES
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
 NOTES
REFERENCES
 
This work was supported by a VA Merit Review Grant award to Dr. Burg, and by an award (0030190N) from the American Heart Association to Dr. Lampert.

Received for publication June 4, 2004.


   REFERENCES
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 DISCUSSION
 NOTES
 REFERENCES
 

  1. Reich P, DeSilva RA, Lown B, et al. Acute psychological disturbances preceding life-threatening ventricular arrhythmias. JAMA 1981; 246: 233–5.[Abstract/Free Full Text]
  2. Engel GL. Sudden and rapid death during psychological stress. Ann Intern Med 1971; 74: 771–82.
  3. Leor J, Poole WK, Kloner RA. Sudden cardiac death triggered by an earthquake. N Engl J Med 1996; 334: 413–9.[Abstract/Free Full Text]
  4. Meisel SR, Kutz I, Dayan KI, Pauzner H, Chetboun I, Arbel Y, David D. Effect of Iraqi missile war on incidence of acute myocardial infarction and sudden death in Israeli civilians. Lancet 1991; 338: 660–1.[CrossRef][Medline]
  5. Peters RW, McQuillan S, Resnick SK, Gold MR. Increased Monday incidence of life-threatening ventricular arrhythmias. Circulation 1996; 94: 1346–9.[Abstract/Free Full Text]
  6. Stamler JS, Goldman ME, Gomes J, Matza D, Horowitz SF. The effect of stress and fatigue on cardiac rhythm in medical interns. J Electrocardiogr 1992; 25: 333–8.
  7. Sgoifo A, Koolhaas JM, Musso E, De Boer SF. Different sympathovagal modulation of heart rate during social and nonsocial stress episodes in wild-type rats. Physiol Behav 1999; 67: 733–8.[CrossRef][Medline]
  8. Kop WJ, Krantz DS, Nearing BD, Gottdiener JS, Quigley JF, O’Callahan M, DelNegro AA, Friehling TD, Karasik P, Suchday S, Levine J, Verrier RL. Effects of acute mental stress and exercise on T-wave alterans in patients with implantable cardioverter defibrillators and controls. Circulation 2004; 109: 1864–9.[Abstract/Free Full Text]
  9. Lampert R, Jain D, Burg MM, Batsford WP, McPherson CA. Destabilizing effects of mental stress on ventricular arrhythmias in patients with implantable cardioverter-defibrillators. Circulation 2000; 101: 158–64.[Abstract/Free Full Text]
  10. Kirby DA, Pinto JMB, Hottinger S, Johnson DA, Lown B. Behavioral arousal enhances inducibility and rate of ventricular tachycardia. Am J Physiol 1991; 261: H1734–9.
  11. Lampert R, Rosenfeld L, Batsford W, Lee F, McPherson C. Circadian variation of sustained ventricular tachycardia in patients with coronary artery disease and implantable cardioverter-defibrillators. Circulation 1994; 90: 241–7.[Abstract/Free Full Text]
  12. Turton MB, Deegan T. Circadian variations of plasma catecholamines, cortisol, and immunoreactive insulin concentrations in supine subjects. Clin Chim Acta 1974; 55: 389–97.[CrossRef][Medline]
  13. Huikuri HV, Niemela MJ, Ojala S, Rantala A, Ikaheimo MJ, Airaksinen KE. Circadian rhythms of frequency domain measures of heart rate variability in healthy subjects and patients with coronary artery disease. Circulation 1994; 90: 121–6.[Abstract/Free Full Text]
  14. Rozanski A, Blumenthal JA, Kaplan J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation 1999; 99: 2192–217.[Abstract/Free Full Text]
  15. Burg MM, Jain D, Soufer R, Kerns RD, Zaret BL. Role of behavioral and psychological factors in mental stress induced silent left ventricular dysfunction in coronary artery disease. J Am Coll Cardiol 1993; 22: 440–8.[Abstract]
  16. Gullette ECD, Blumenthal JA, Babyak M, et al. Effects of mental stress on myocardial ischemia during daily life. JAMA 1997; 277: 1521–6.[Abstract/Free Full Text]
  17. Burg MM, Malkin A, Lampert R, Jain D, Batsford W. Psychological factors in AICD pacing and discharge. Psychosom Med 1999; 61: 126.
  18. Mittleman MA, Maclure M, Sherwood JB, Mulry RP, Tofler GH, Jacobs SC, Friedman R, Benson H, Muller JE. Triggering of acute myocardial infarction onset by episodes of anger. Determinants of Myocardial Infarction Onset Study Investigators. Circulation 1995; 92: 1720–5.[Abstract/Free Full Text]
  19. Lampert R, Joska T, Burg MM, Batsford WP, McPherson CA, Jain D. Emotional and physical precipitants of ventricular arrhythmia. Circulation 2002; 106: 1800–5.[Abstract/Free Full Text]
  20. Spielberger CD. Manual for the state-trait personality inventory. Palo Alto, CA: Consulting Psychologists; 1983.
  21. Spielberger CD, Johnson EH, Russell SF, Crane RJ, Jacobs GA, Worden TJ. The experience and expression of anger: construction and validation of an anger expression scale. In: Chesney M, Rosenman R, editors. Anger and hostility in cardiovascular and behavioral disorders. New York: McGraw-Hill; 1995. p. 5–30.
  22. Barefoot JC, Dodge KA, Peterson BL, Dahlstrom WG, Williams RB Jr. The Cook-Medley hostility scale: item content and ability to predict survival. Psychosom Med 1989; 51: 46–57.[Abstract/Free Full Text]
  23. Maclure M. The case-crossover design: a method for studying transient effects on the risk of acute events. Am J Epidemiol 1991; 133: 144–53.[Abstract/Free Full Text]
  24. Rozanski A, Bairey CN, Krantz DS, Friedman J, Resser KJ, Morell M, Hilton-Chalfen S, Hestrin L, Bietendorf J, Berman DS. Mental stress and the induction of silent myocardial ischemia in patients with coronary artery disease. N Engl J Med 1988; 318: 1005–12.[Abstract]
  25. Blumenthal JA, Jiang W, Waugh RA, Frid DJ, Morris JJ, Coleman RE, Hanson M, Babyak M, Thyrum ET, Krantz DS, O’Connor C. Mental stress-induced ischemia in the laboratory and ambulatory ischemia during daily life. Circulation 1995; 92: 2102–8.[Abstract/Free Full Text]
  26. Ironson G, Taylor CB, Boltwood M, Bartzokis T, Dennis C, Chesney M, Spitzer S, Segall GM. Effects of anger on left ventricular ejection fraction in coronary artery disease. Am J Cardiol 1992; 70: 281–5.[CrossRef][Medline]
  27. Ford DE, Mead LA, Chang PP, Cooper-Patrick L, Wang NY, Klag MJ. Depression as a risk factor for coronary artery disease in men: the precursors study. Arch Intern Med 1998; 158: 1422–6.[Abstract/Free Full Text]
  28. Carney RM, Rich MW, Freedland KE, Saini J, Tevelde A, Simeone C, Clark K. Major depressive disorder predicts cardiac events in patients with coronary artery disease. Psychosom Med 1988; 50: 627–33.[Abstract/Free Full Text]
  29. Frasure-Smith N. In-hospital symptoms of psychological stress as predictors of long-term outcome after acute myocardial infarction in men. Am J Cardiol 1991; 67: 121–7.[CrossRef][Medline]
  30. Frasure-Smith N, Lesperance F, Talajic M. Depression and 18-month prognosis after myocardial infarction. Circulation 1995; 91: 999–1005.[Abstract/Free Full Text]
  31. Fraure-Smith N, Lesperance F. Depression and other psychological risks following myocardial infarction. Arch Gen Psychiatry 2003; 60: 627–36.[Abstract/Free Full Text]
  32. Strik JJMH, Denollet J, Lousberg R, Honig A. Comparing symptoms of depression and anxiety as precursors of cardiac events and increased health care consumption after myocardial infarction. J Am Coll Cardiol 2003; 42: 1801–7.[Abstract/Free Full Text]
  33. Dunbar SB, Kimble LP, Jenkins LS, Hawthorne M, Dudley W, Slemmons M, Langberg JJ. Association of mood disturbance and arrhythmia events in patients after cardioverter defibrillator implantation. Depress Anxiety 1999; 9: 163–8.[CrossRef][Medline]
  34. Tafrate RC, Kassinove H, Dundin L. Anger episodes in high- and low-trait-anger community adults. J Clin Psychol 2002; 58: 1573–90.[CrossRef][Medline]
  35. Schron EB, Exner DV, Yao Q, Jenkins LS, Steinberg JS, Cook JR, Kutalek SP, Friedman PL, Bubien RS, Page RL, Powell J, AVID Investigators. Quality of life in the Arrhythmia Versus Implantable Defibrillators trial. Circulation 2002; 105: 589–94.[Abstract/Free Full Text]
  36. Dougherty CM. Psychological reactions and family adjustment in shock versus no shock groups after implantation of internal cardioverter-defibrillators. Heart Lung 1995; 24: 281–91.[CrossRef][Medline]
  37. Keren R, Aarons D, Veltri EP. Anxiety and depression in patients with life-threatening ventricular arrhythmias: impact of the implantable cardioverter-defibrillator. J Cardiovasc Nurs 1991; 5: 65–76.
  38. Sears SF, Todaro JF, Lewis TS, Sotile W, Conti JB. Examining the psychosocial impact of implantable cardioverter defibrillators: a literature review. Clin Cardiol 1999; 22: 481–9.[Medline]
  39. Sears SF, Conti JB. Quality of life and psychological functioning of ICD patients. Heart 2002; 87: 488–93.[Free Full Text]
  40. Friedman M, Thoresen CE, Gill J, Ulmer D, Powell LH, Price VA, Brown B, Thompson L, Rabin DD, Breall WS, Bourg W, Levy R, Dixon T. Alteration of type-A behavior and its effect on cardiac recurrences in post-myocardial infarction patients: summary results from the Recurrent Coronary Prevention Project. Am Heart J 1986; 112: 653–65.[CrossRef][Medline]
  41. Blumenthal JA, Jiang W, Babyak MA, Krantz DS, Frid DJ, Coleman RE, Waugh R, Hanson M, Appelbaum M, O’Connor C, Morris JJ. Stress management and exercise training in cardiac patients with myocardial ischemia. Effects on prognosis and evaluation of mechanisms. Arch Intern Med 1997; 157: 2213–23.[Abstract/Free Full Text]
  42. Kuijpers PMJC, Honig A, Wellens HJJ. Effect of treatment of panic disorder in patients with frequent ICD discharges: a pilot study. Gen Hosp Psychiatry 2002; 24: 181–4.[CrossRef][Medline]
  43. Jamner L, Shapiro D, Alberts J. Mood, blood pressure, and heart rate: strategies for developing a more effective ambulatory mood diary. In: Krantz D, editor. Perspectives in behavioral medicine. Hillsdale, NJ: Erlbaum; 1998.
  44. Shapiro D, Jamner L, Goldstein I. Ambulatory stress psychophysiology: the study of "compensatory and defense counterforces" and conflict in a natural setting. Psychosom Med 1993; 55: 309–323.[Abstract/Free Full Text]
  45. Shapiro D, Jamner L, Goldstein I. Daily mood states and ambulatory blood pressure. Psychophysiology 1997; 34: 399–405.[Medline]
  46. Virtanen R, Jula A, Salminen JK, Voipio-Pulkki LM, Helenius H, Kuusela T, Airaksinen J. Anxiety and hostility are associated with reduced baroreflex sensitivity and increased beat-to-beat blood pressure variability. Psychosom Med 2003; 65: 751–6.[Abstract/Free Full Text]
  47. Burgess E, Quigley J, Moran G, Sutton FJ, Goodman M. Predictors of psychosocial adjustment in patients with implantable cardioverter-defibrillators. Pacing Clin Electrophysiol 1997; 20: 1790–5.[CrossRef][Medline]
  48. Krantz DS, Kop WJ, Gabbay FH, Rozanski A, Barnard M, Klein J, Pardo Y, Gottdiener JS. Circadian variation of ambulatory myocardial ischemia. Triggering by daily activities and evidence for an endogenous circadian component. Circulation 1996; 93: 1364–71.[Abstract/Free Full Text]



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