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Review
. 2022 Feb 3:12:813518.
doi: 10.3389/fpsyt.2021.813518. eCollection 2021.

Anxiety, Mental Stress, and Sudden Cardiac Arrest: Epidemiology, Possible Mechanisms and Future Research

Neeltje M Batelaan  1   2 , Adrie Seldenrijk  1   2 , Odile A van den Heuvel  1   3   4 , Anton J L M van Balkom  1   2 , Antonia Kaiser  5   6 , Liesbeth Reneman  5 , Hanno L Tan  7   8
Affiliations
Review

Anxiety, Mental Stress, and Sudden Cardiac Arrest: Epidemiology, Possible Mechanisms and Future Research

Neeltje M Batelaan et al. Front Psychiatry. .

Abstract

Sudden cardiac arrest (SCA) is a leading cause of mortality and morbidity in affluent societies, which underscores the need to identify persons at risk. The etiology of SCA is however complex, with predisposing and precipitating factors interacting. Although anxiety and mental stress have been linked to SCA for decades, their precise role and impact remain unclear and the biological underpinnings are insufficiently understood. In this paper, we systematically reviewed various types of observational studies (total n = 20) examining the association between anxiety or mental stress and SCA. Multiple methodological considerations challenged the summarizing and interpretation of the findings. For anxiety, the overall picture suggests that it predisposes for SCA in physically healthy populations (unadjusted OR = 2.44; 95% CI: 1.06-5.59; n = 3). However, in populations at risk for SCA (n = 4), associations were heterogeneous but not significant. Anxiety may partly predispose to SCA by contributing to other risk factors such as cardiovascular disease and diabetes mellitus via mechanisms such as unhealthy lifestyle and metabolic abnormalities. Mental stress appears to precipitate SCA, presumably by more directly impacting on the cardiac ion channels that control the heart's electrical properties. This may lead to ventricular fibrillation, the arrhythmia that underlies SCA. To advance this field of research, experimental studies that unravel the underlying biological mechanisms are deemed important, and most easily designed for mental stress as a precipitating factor because of the short timeframe. These proof-of-concept studies should examine the whole pathway from the brain to the autonomic nervous system, and eventually to cardiac ion channels. Ultimately, such studies may facilitate the identification of persons at risk and the development of novel preventive strategies.

Keywords: anxiety; biological mechanism; mental stress; predisposing and precipitating risk factors; sudden cardiac arrest (SCA); sudden cardiac death (SCD).

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Pooled unadjusted effect measures of studies on anxiety symptoms and SCD in physically healthy individuals.
Figure 2
Figure 2
Pooled unadjusted effect measures of studies on anxiety and SCA in individuals with elevated SCA risk.
See this image and copyright information in PMC

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