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T-wave alternans and emotion in daily life

T波交替与日常生活中的情绪

基本信息

批准号：
8271377
负责人：
Rachel Lampert
金额：
$ 8.15万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-05-01 至 2014-01-30
项目状态：
已结题

项目摘要

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(申请人提供)：愤怒和其他强烈的情绪会引发室性心律失常(VA)。例如，在2001年世贸中心袭击事件后的几周里，VAS增加了。此外，愤怒可以在植入心脏转复除颤器(ICD)的患者中触发多态的、潜在致命的VAS。然而，情绪诱发心律失常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，它在室颤发生之前立即出现，提示存在机制关系。此外，环球航空预测易受猝死和退伍军人病症的影响。然而，日常生活中发生的愤怒是否会增加TWA的水平尚不清楚，TWA是一种潜在的导致心律失常的现象。基于情绪和室性心律失常之间的这些联系，一项计划中的临床试验“降低ICD休克治疗室性心律失常的易感性”(Burg，1R01HL084438-01A1)将随机选择接受ICD的患者接受应激缓解治疗(SRT)或标准护理，以确定1)应激减轻治疗(SRT)是否会降低VA的风险，2)SRT是否会降低TWA对实验室急性应激的反应，3)SRT通过24小时动态心电图记录(Holter)改变心率变异性。这项辅助研究将评估在计划的24小时内，在自然主义环境下情绪对TWA的影响。为了实现这一点，首先，将使用一种新的系统来采集录音，该系统将数据采集中的更高保真度与内置分析算法相结合，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愤怒和其他情绪的水平，这将与同时获得的TWA水平相关。这项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的VA和ICD风险患者的TWA测量的复极不稳定性。下一个目标是检验情绪对日常生活中复极不稳定性的影响是否可以通过实验室中的人来预测。最终目标是评估日常生活中愤怒导致的TWA增加是否与随后的VA相关。确定情绪导致心律失常的潜在机制是指导未来治疗干预的重要一步。