Psychological distress and arrhythmia: risk prediction and potential modifiers

Abstract

The connection between the heart and the brain has long been anecdotally recognized but has systematically been studied only relatively recently. Cardiac arrhythmias, especially ventricular arrhythmias that can lead to sudden cardiac death, remain a major public health concern and there is mounting evidence that psychological distress plays a critical role both as a predictor of high-risk cardiac substrate and as an inciting trigger. The transient, unpredictable nature of emotions and cardiac arrhythmias has made their study challenging, but evolving technologies in monitoring and imaging along with larger epidemiological data sets have encouraged more sophisticated studies examining this relationship. Here we review the research on psychological distress including anger, depression and anxiety on cardiac arrhythmias, insights into proposed mechanisms, and potential avenues for future research.

Figure 1

Schematic representation of the proposed relationship between psychological distress and cardiac arrhythmias. Emotions can predict cardiovascular substrate at risk for arrhythmias and can trigger arrhythmias. Arrhythmias and high-risk heart conditions can precipitate psychological distress.

Figure 2

Schematic representation of potential therapies for sudden cardiac death in high-risk post-MI patients suffering from depression.