T-wave alternans and emotion in daily life

T波交替与日常生活中的情绪

• 批准号: 7616677
• 负责人: Rachel Lampert
• 金额: $ 41.77万
• 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/7616677
• 关键词: Abbreviations; Algorithms; Ancillary Study; Anger; Animal Model; Anxiety; Arrhythmia; Arts; Cardiology; Clinical Trials; Data; Development; Disasters; Doctor of Philosophy; Earthquakes; Electrocardiogram; Emotional; Emotions; Engineering Psychology; Epidemiologic Studies; Equilibrium; Frequencies; Future; Goals; Health; 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; Stress; Sudden Death; System; Techniques; Testing; Therapeutic Intervention; Ventricular; Ventricular Arrhythmia; Ventricular Fibrillation; Ventricular Tachycardia; War; acute stress; base; data acquisition; egg; experience; follow-up; heart rate variability; mind body interaction; physical conditioning; programs; psychologic; response; standard care; 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）：愤怒等强烈情绪可引发室性心律失常（VA）。例如，在2001年世贸中心遇袭后情绪激动的几周内，VAs有所上升。此外，愤怒会引发植入心律转复除颤器（icd）患者的多态、潜在致命的VAs。然而，情绪诱发心律失常的电生理机制尚不清楚。我们已经证明，在实验室环境下，愤怒会增加t波交替（TWA）的水平。TWA是复极不稳定的标志，在心室颤动发生之前立即发生，表明两者之间存在机制关系。此外，TWA预示着猝死和VA的易感性。然而，日常生活中发生的愤怒是否会增加TWA水平，这是一种潜在的心律失常现象，尚不清楚。基于这些情绪和室性心律失常之间的联系，一项计划中的临床试验“降低对ICD休克治疗室性心律失常的易感性”（Burg, 1R01HL084438-01A1）将随机分配接受ICD的患者接受减压治疗（SRT）或标准治疗，以确定1)SRT是否会降低室性心律失常的风险，2)SRT是否会降低TWA对实验室急性应激的反应，以及3)SRT是否会改变心率变异性，这是由24小时动态EGG记录（holter）得出的。本辅助研究将评估情绪在24小时的自然情境下对TWA的影响。为了实现这一目标，首先，将使用一种新的系统来获取记录，该系统将数据采集的保真度提高，以提高TWA分析的精度，并使用内置的分析算法。当受试者进行24小时动态呼吸时，最先进的生态瞬间评估技术将测量日常生活中愤怒和其他情绪的水平，这些情绪将与同时获得的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复极不稳定性，这是由TWA测量的，在已知有VA和icd风险的患者中。下一个目标是检验日常生活中情绪对复极不稳定性的影响是否可以通过实验室的研究来预测。最终目的是评估日常生活中愤怒引起的TWA增加是否与随后的VA相关。确定情绪致心律失常作用的机制是指导未来治疗干预的重要一步。