Chicago, IL - In patients with an implantable cardioverter defibrillator (ICD), anger management could go a long way toward reducing ventricular tachycardia/ventricular fibrillation (VT/VF) events, thus reducing the number of painful shocks needed to convert the heart to normal rhythm, a new study has shown.

Dr Christine Albert

Presenting data last week at the American Heart Association 2006 Scientific Sessions, lead investigator Dr Christine Albert (Harvard Medical School, Boston, MA) and colleagues report that acute episodes of moderate anger were associated with a significantly greater risk of ICD discharge.

"None of the patients want to be shocked by their defibrillator, so if they know that something they're doing might precipitate that, they might try to modify their behavior," said Albert.

The rationale for the study, explained Albert during a briefing for the media, was to examine the triggers of arrhythmia in patients with an ICD. In this multicenter, prospective cohort study, 1188 patients with an ICD were asked to report to the hospital any time the device delivered a shock and to complete a questionnaire about how they were feeling before the ICD discharge. Information on the exposure to triggers prior to the ICD shock was collected within 72 hours, and stored electrograms were studied to confirm the cardiac rhythm underlying each ICD shock.

A total of 199 cases of VT/VF were recorded in the study. The relative risk of ICD discharge for VT/VF within one hour of exposure to at least moderate levels of anger was 3.2 as compared with the risk during periods of lesser or no anger. If patients were very angry or furious, there was a 16-fold increased risk of ICD discharge for VT/VF.

Although the study did not address how anger caused the arrhythmia, Albert told heartwire that previous studies have shown the development of T-wave alternans when patients became angry. In addition, the sympathetic nervous system is thought to be a driver of arrhythmia, and this system is highly activated during periods of stress and anger, she said. Albert cautioned, however, about extrapolating the findings to the general population, because the patients in this study are high risk and predisposed to arrhythmias. In terms of a clinical message, it might help to tell ICD patients not to get too worked up.

"The motivation for a lot of patients in this study was that they really wanted to understand what kinds of things they could or could not do. Our patients ask us these questions all the time," said Albert. "We try everything we can as physicians to minimize the amount that they get shocked, but often we don't talk to them about what they can do."