Risk of Ventricular Arrhythmia After Implantable Defibrillator Treatment in Anxious Type D Patients

• Published in: Journal of the American College of Cardiology 2009-08, Vol.54 (6), p.531-537
• Main Authors: van den Broek, Krista C., PhD, Nyklíček, Ivan, PhD, van der Voort, Pepijn H., MD, Alings, Marco, MD, PhD, Meijer, Albert, MD, PhD, Denollet, Johan, PhD
• Format: Article
• Language: English
• Subjects: Age; Aged; Anxiety; Anxiety Disorders - epidemiology; Arrhythmias, Cardiac - etiology; Arrhythmias, Cardiac - psychology; Biological and medical sciences; Cardiac arrhythmia; Cardiac dysrhythmias; Cardiology; Cardiology. Vascular system; Cardiovascular; Confidence intervals; Defibrillators, Implantable - adverse effects; Defibrillators, Implantable - psychology; depression; Depressive Disorder - epidemiology; Enzymes; Female; Heart; Heart attacks; Humans; implantable defibrillator; Internal Medicine; Inventory; Likert scale; Male; Medical sciences; Middle Aged; Mortality; Older people; Personality; Personality - classification; Personality traits; Risk Factors; Studies; Type D personality; ventricular arrhythmias
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2009.04.043

Objectives We sought to examine the combination of adverse psychological factors (anxiety, depression, and distressed or Type D personality) as a predictor of ventricular arrhythmias in patients with implantable cardioverter-defibrillators (ICDs). Background Little is known about the role of psychological factors and their clustering in the occurrence of life-threatening arrhythmias. Methods In this prospective study, 391 patients with an ICD (81% men, age 62.3 ± 10.4 years) completed anxiety, depression, and Type D personality scales at the time of implantation. The end point was occurrence of ventricular arrhythmia, defined as appropriate ICD therapies, in the first year after implantation. Results Ventricular arrhythmias occurred in 19% (n = 75) of patients. Increased symptoms of depression (p = 0.81) or anxiety (p = 0.31) did not predict arrhythmias. However, anxious patients with a Type D personality had a significantly increased rate of ventricular arrhythmias (21 of 71; 29.6%) as compared with other ICD patients (54 of 320; 16.9%; hazard ratio [HR]: 1.89; 95% confidence interval [CI]: 1.14 to 3.13; p = 0.013). When controlled for the effects of sex, age, ischemic etiology, left ventricular dysfunction, prolonged QRS duration, and medication, anxious Type D patients (HR: 1.72; 95% CI: 1.03 to 2.89; p = 0.039) and secondary prevention patients (HR: 1.91; 95% CI: 1.14 to 3.20; p = 0.014) were at increased risk of ventricular arrhythmias. Conclusions Personality modulated the effect of emotional distress; anxiety predicted a 70% increase in risk of arrhythmia in Type D patients but not in other patients. Anxious Type D patients may be identified and offered additional behavioral support after ICD implantation.