Emotional Reactivity: A Trigger of Atrial Fibrillation

情绪反应：心房颤动的触发因素

• 批准号: 7226713
• 负责人: Rachel Lampert
• 金额: $ 37.79万
• 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 2009-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7226713
• 关键词: Affect; American; Anger; Anxiety; Arousal; Arrhythmia; Atrial Fibrillation; Blood Pressure; Cardiovascular Diseases; Cardiovascular system; Case Series; Cohort Studies; Condition; Crossover Design; EKG P Wave; Economic Burden; Electrophysiology (science); Emotional; Emotions; Endocrine; Evaluation; Event; Exercise; Feedback; Frequencies; Future; Goals; Heart Atrium; Hostility; Hypertension; Implantable Defibrillators; Individual; Invasive; Ischemia; Laboratories; Lead; Link; Measures; Mediating; Morbidity - disease rate; Nature; Neurosecretory Systems; Other Finding; Pathway interactions; Patients; Perception; Personal Satisfaction; Physiological; Protocols documentation; Psyche structure; Psychological Factors; Psychological Tests; Recurrence; Reporting; Research; Research Design; Research Personnel; Risk; Score; Shock; Signal Transduction; Societies; Stimulus; Stress; Stress Tests; Stroke; Symptoms; Therapeutic Intervention; Ventricular Arrhythmia; Withdrawal; base; electrical property; emotional factor; emotional stimulus; follow-up; hemodynamics; mental set; mortality; programs; prospective; psychologic; psychosocial; response; trait

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.

说明(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)，给社会带来巨大的经济负担。虽然高血压和心血管疾病等易患房颤(AF)的条件已被很好地描述，但究竟是什么因素触发了房颤的实际发生尚不清楚。情绪，通过激活交感神经通路，可能触发房颤发作。虽然已经描述了“肾上腺素介导的”心房颤动患者组，但情绪刺激可以触发房颤的证据仅来自小的病例系列。我们先前的研究表明，愤怒可以诱发植入性心律转复除颤器(ICD)患者的室性心律失常。在那项研究中，因房颤而“不当”接受电击的小组中，有40%是由愤怒或焦虑引起的。虽然心理应激对心房电特性的影响尚未得到很好的描述，但药物自主神经操作可以改变心房电生理，支持情绪引起交感兴奋有可能触发房颤的假说。这项研究的主要目的是确定情绪因素是否能触发症状性阵发性或持续性房颤患者的症状性心房颤动发作，采用病例交叉设计，每个患者作为自己的对照。我们假设，在阵发性或间歇性房颤患者中，愤怒和焦虑会先于房颤发作。我们还建议在一项平行的前瞻性队列研究中，研究个体的情绪反应性(通过在实验室环境中对诱导心理应激测试的反应来衡量)和心理特征是否可以预测房颤复发的可能性和频率，就像对其他心血管事件的发现一样。我们假设，那些在心理应激测试中表现出更强的交感反应的患者，根据全面的血液动力学、神经内分泌和无创电生理评估，在随访中将有更早和更频繁的房颤复发。此外，我们假设在心理测试中愤怒、焦虑和敌意得分较高的患者也有较高的房颤复发倾向。确定房颤的诱因，并确定复发风险增加的个体，可能会导致未来的治疗干预，旨在减少诱因对个体患者的影响。