Psychological traits and emotion-triggering of ICD shock-terminated arrhythmias

We have previously reported on the triggering of arrhythmia and hence, implanted cardioverter-defibrillators (ICD) shock by strong emotion. The purpose of the present study was to examine whether concordant psychological traits distinguish patients who experience emotion-triggered ICD shock.

Two hundred forty ICD patients completed the Speilberger Trait Anxiety and Anger Inventories and Anger Expression Scale, and the abridged Cook-Medley Hostility Scale approximately 2 months after ICD implantation. Patients were also given a structured diary to record mood states retrospectively for the period 0 to 15 minutes preceding ICD shock and for a period corresponding to the same time of day 1 week later. Patients who reported emotion-triggered ICD shock were compared on concordant psychological measures to patients who did not.

Patients who reported at least moderate anger in the 0 to 15 minutes before ICD shock scored significantly higher on Speilberger Trait Anger (24.18 +/- 3.97 vs. 17.04 +/- 2.17, p < .0001), and Cook-Medley Aggressive Responding (5.76 +/- 0.75 vs. 3.96 +/- 1.30, p < .0001) and Hostile Affect (3.59 +/- 0.80 vs. 2.04 +/- 1.02, p < .0001), and lower on Speilberger Anger Control (7.94 +/- 1.43 vs. 10.64 +/- 1.19, p < .001) than those who did not. In multivariate analysis, only Trait Anger remained a significant predictor of anger-triggered shock (chi2 = 7.10, p < .008). Patients who reported at least moderate anxiety in the 0 to 15 minutes before ICD shock scored significantly higher on Speilberger Anxiety (22.43 +/- 1.65 vs. 19.96 +/- 1.71, p < .0001) than those who did not.

Stable psychological factors are associated with risk for ICD-shock triggered by concordant strong emotion.