Emotional Reactivity: A Trigger of Atrial Fibrillation

情绪反应：心房颤动的触发因素

• 批准号: 6886095
• 负责人: Rachel Lampert
• 金额: $ 40.75万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-05-01 至 2008-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6886095
• 关键词: angers; anxiety; atrial fibrillation; behavioral /social science research tag; cardiovascular disorder risk; catecholamines; clinical research; electrocardiography; electrophysiology; hemodynamics; human subject; neuroendocrine system; patient oriented research; psychological tests; psychophysiology; stress; sympathetic nervous system

DESCRIPTION (provided by applicant): Atrial fibrillation is the most common arrhythmia, affecting two million Americans per year, increasing mortality and morbidity (stroke) with significant economic burden on society. While the conditions predisposing to atrial fibrillation (AF), such as hypertension and cardiovascular disease, are well described, what factors trigger the actual occurrence of an episode of AT are unknown. Emotion, through activation of sympathetic pathways, may trigger episodes of AF. Although groups of patients with "adrenergically-mediated" atrial fibrillation have been described, evidence that emotional stimuli can trigger AF comes only from small case-series. Our prior research has shown that anger can precipitate ventricular arrhythmias in patients with implantable cardioverter-defibrillators (ICDs). In that study, 40% of the small group of shocks received "inappropriately" for AF were precipitated by anger or anxiety. While effects of mental stress on electrical properties of the atrium have not been well described, pharmacological autonomic manipulations can alter atrial electrophysiology, supporting the hypothesis that sympathetic arousal by emotion has the potential to trigger AF. The primary goal of the proposed study is to determine whether emotional factors can trigger episodes of symptomatic atrial fibrillation in patients with symptomatic paroxysmal or persistent AF, using a case-crossover design, in which each patient acts as his own control. We hypothesize that anger and anxiety will precede episodes of AF in patients with paroxysmal or intermittent AF. We also propose to investigate, in a parallel prospective cohort study, whether an individual's emotional reactivity, as measured by response to induced mental stress testing in the laboratory setting, ("mental stress reactivity") and by psychological profile, can predict the likelihood and frequency of AF recurrence, as has been found for other cardiovascular events. We hypothesize that those patients demonstrating greater sympathetic response during mental stress testing, as determined by comprehensive hemodynamic, neuroendocrine, and non-invasive electrophysiological evaluation, will have earlier and more frequent recurrences of AF in follow-up. Further, we hypothesize that patients scoring higher on measures of anger, anxiety, and hostility on psychological testing will have also have a higher propensity to recurrent AF. Determining triggers of AF, and identifying individuals at increased risk of recurrence, may lead to future therapeutic interventions aimed at decreasing the effects of triggers on the individual patient.

描述（由申请人提供）：房颤是最常见的心律失常，每年影响200万美国人，增加死亡率和发病率（中风），对社会造成重大经济负担。虽然诱发房颤（AF）的条件，如高血压和心血管疾病，得到了很好的描述，但什么因素触发AT发作的实际发生是未知的。情绪，通过激活交感神经通路，可能会触发AF的发作。虽然“肾上腺素介导的”房颤患者组已被描述，证据表明，情绪刺激可以触发AF来自小的病例系列。我们之前的研究表明，愤怒可以促使植入心脏复律器（ICD）的患者发生室性心律失常。在这项研究中，40%的房颤患者因愤怒或焦虑而受到“不适当”的电击。虽然精神压力对心房电特性的影响尚未得到很好的描述，但药理学自主操作可以改变心房电生理学，支持情绪引起的交感神经兴奋有可能触发AF的假设。拟议研究的主要目标是确定情绪因素是否可以触发症状性阵发性或持续性AF患者的症状性房颤发作，使用病例交叉设计，其中每个患者作为自己的对照。我们假设阵发性或间歇性房颤患者的房颤发作前会出现愤怒和焦虑。我们还建议在一项平行的前瞻性队列研究中，通过在实验室环境中对诱导的精神压力测试的反应来测量个体的情绪反应，通过心理应激反应（“精神应激反应”）和心理特征，可以预测AF复发的可能性和频率，如已经发现的其他心血管事件。我们假设，通过全面的血流动力学、神经内分泌和无创电生理评估确定，那些在精神压力测试中表现出更大交感神经反应的患者在随访中将更早、更频繁地复发AF。此外，我们假设，患者得分较高的措施，愤怒，焦虑和敌意的心理测试也将有较高的倾向复发AF。确定触发AF，并确定个人复发的风险增加，可能会导致未来的治疗干预，旨在减少触发对个别患者的影响。