T-wave alternans and emotion in daily life

T波交替与日常生活中的情绪

• 批准号: 7297390
• 负责人: Rachel Lampert
• 金额: $ 42.33万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-05-01 至 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7297390
• 关键词: Abbreviations; Algorithms; Ancillary Study; Anger; Animal Model; Anxiety; Arrhythmia; Arts; Cardiology; Caring; Clinical Trials; Daily; Data; Development; Disasters; Doctor of Philosophy; Earthquakes; Electrocardiogram; Emotional; Emotions; Engineering Psychology; Epidemiologic Studies; Equilibrium; Frequencies; Future; Goals; Health; Heart Rate; Hour; Human; Implantable Defibrillators; Incidence; Individual; Laboratories; Life; Link; Living Wills; Measures; Mediating; Parents; Pathway interactions; Patients; Physiological; Population; Randomized; Research; Research Personnel; Risk; Shock; Standards of Weights and Measures; Stress; Sudden Death; System; Techniques; Testing; Therapeutic Intervention; Ventricular; Ventricular Arrhythmia; Ventricular Fibrillation; Ventricular Tachycardia; War; Week; acute stress; base; data acquisition; egg; experience; follow-up; mind body interaction; programs; psychologic; response; trait

DESCRIPTION (provided by applicant): Anger and other strong emotion can trigger ventricular arrhythmias (VA). For example, VAs increased in the emotional weeks following the World Trade Center attacks in 2001. Further, anger can trigger polymorphic, potentially lethal VAs in patients with implantable cardioverter-defibrillators (ICDs). However, the electrophysiological mechanisms underlying the arrhythmogenic effects of emotion remain unknown. We have shown that in the laboratory setting, anger increases levels of T-wave alternans (TWA). TWA is a marker of repolarization instability which immediately precedes development of ventricular fibrillation, suggesting a mechanistic relationship. Further, TWA predicts vulnerability to sudden death and VA. However, whether anger occurring in everyday life can increase levels of TWA, a potentially arrhythmogenic phenomenon, is unknown. Based on these links between emotion and VA, a planned clinical trial, "Reducing Vulnerability to ICD Shock Treated Ventricular Arrhythmias" (Burg, 1R01HL084438-01A1) will randomize patients receiving ICDs to receive stress reduction treatment (SRT) or standard care, to determine whether 1) SRT will reduce risk of VA, 2) SRT will decrease the response of TWA to acute stress in the laboratory, and 3) SRT alters heart-rate variability, derived from 24-hour ambulatory EGG recording (holter). This ancillary study will evaluate effects of emotion on TWA in the naturalistic setting during the planned 24-hour holters. To achieve this, first, the recordings will be acquired using a new system which combines increased fidelity in data acquisition, for increased precision of TWA analysis, with built-in analytic algorithms. While subjects undergo this 24-hour holter, state-of-the-art techniques in ecological momentary assessment will measure levels of anger and other emotions in daily life, which will be correlated with simultaneously-acquired levels of TWA. The first goal of this study is to determine whether anger and anxiety in daily life will increase repolarization instability, as measured by TWA, in patients with known risk for VA and ICDs. The next goal is to examine whether effects of emotion on repolarization instability in daily life can be predicted by those in the laboratory. The final goal is to evaluate whether greater anger-induced increases in TWA during daily life correlate with subsequent VA. Determining mechanisms underlying the arrhythmogenic effects of emotion is an important step in guiding future therapeutic interventions.

描述（由申请人提供）：愤怒和其他强烈情绪可触发室性心律失常（VA）。例如，在2001年世界贸易中心袭击事件后情绪激动的几周内，VA增加了。此外，愤怒可以触发多态性，潜在致命的VA患者植入心律转复除颤器（ICD）。然而，情绪的致痫效应背后的电生理机制仍不清楚。我们已经证明，在实验室环境中，愤怒会增加T波交替（TWA）的水平。TWA是复极不稳定性的标志，其紧接在心室颤动发展之前，表明了一种机制关系。此外，TWA预测猝死和VA的脆弱性。然而，日常生活中发生的愤怒是否会增加TWA的水平，这是一种潜在的致癌现象，目前尚不清楚。基于情绪和VA之间的这些联系，一项计划中的临床试验“降低ICD电击治疗室性心律失常的脆弱性”（布尔格，1 R 01 HL 084438 - 01 A1）将随机分配植入ICD的患者接受减压治疗（SRT）或标准治疗，以确定1）SRT是否会降低VA的风险，2）SRT是否会降低实验室中TWA对急性应激的反应，和3）SRT改变心率变异性，来自24小时动态心电图记录（霍尔特）。这项辅助研究将在计划的24小时动态心电图期间，在自然环境中评价情绪对TWA的影响。为了实现这一目标，首先，将使用一种新的系统来采集记录，该系统将数据采集中的保真度提高与内置的分析算法相结合，以提高TWA分析的精度。当受试者接受24小时霍尔特动态心电图时，最先进的生态瞬时评估技术将测量日常生活中的愤怒和其他情绪水平，这将与错误获得的TWA水平相关。本研究的第一个目标是确定日常生活中的愤怒和焦虑是否会增加已知VA和ICD风险患者的复极不稳定性（通过TWA测量）。下一个目标是研究日常生活中情绪对复极不稳定性的影响是否可以由实验室中的人预测。最终目标是评估日常生活中愤怒诱导的TWA增加是否与随后的VA相关。确定情绪的致瘤效应的机制是指导未来治疗干预的重要一步。