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CLINICAL RESEARCH: HEART RHYTHM DISORDER

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

Krista C. van den Broek, PhD^_*,_*, Ivan Nyklíek, PhD^_*, Pepijn H. van der Voort, MD, Marco Alings, MD, PhD, Albert Meijer, MD, PhD and Johan Denollet, PhD^_*

^_* CoRPS (Center of Research on Psychology in Somatic diseases), Tilburg University, Tilburg, the Netherlands
Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
Department of Cardiology, Amphia Hospital, Breda, the Netherlands

Manuscript received February 9, 2009; revised manuscript received March 30, 2009, accepted April 26, 2009.

^_* Reprint requests and correspondence: Dr. Krista C. van den Broek, CoRPS, Tilburg University, Department of Medical Psychology, Room P612, P.O. Box 90153, 5000 LE Tilburg, the Netherlands (Email: CvdBroek{at}uvt.nl).

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.

Key Words: implantable defibrillator • ventricular arrhythmias • depression • anxiety • Type D personality

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   ATP = antitachycardia pacing   BDI = Beck Depression Inventory   CI = confidence interval   DS14 = Type D scale   HR = hazard ratio   ICD = implantable cardioverter-defibrillator   STAI = State Trait Anxiety Inventory

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