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Prevention of implantable defibrillator shocks by cognitive behavioral therapy: a pilot trial
Philippe Chevalier1, Jean Cottraux, Evelyne Mollard
1Cardiology and Intensive Care Department, Hôpital Cardiologique, Lyon, France. philippe.chevalier@chu-lyon.fr
Insights
Cognitive behavioral therapy (CBT) may reduce ventricular arrhythmias in implantable cardioverter-defibrillator (ICD) patients by improving stress and heart rate variability. However, these benefits seem to diminish over time.
Area of Science:
- Cardiology
- Psychology
- Medical Interventions
Background:
- Psychological stress is linked to ventricular arrhythmias in implantable cardioverter-defibrillator (ICD) patients.
- No prior evidence shows stress management interventions reduce ventricular electrical instability in ICD patients.
Purpose of the Study:
- To determine if cognitive behavioral therapy (CBT) decreases arrhythmic events requiring ICD intervention.
- To assess if CBT improves sympathovagal balance in ICD patients.
Main Methods:
- 70 ICD patients were randomized to CBT or conventional care.
- Heart rate variability, psychological well-being, and quality of life were measured.
- Primary outcome was appropriate ICD shock.
Main Results:
- Fewer patients in the CBT group required shocks, though not statistically significant.
- At 3 months, no CBT patients without antiarrhythmic drugs had arrhythmic events vs. 4 controls (P < .05).
- Daytime and nocturnal heart rate variability indexes improved significantly in the CBT group.
Conclusions:
- CBT may reduce ventricular arrhythmias in ICD patients by decreasing anxiety and improving sympathovagal balance.
- The positive effects of CBT on ventricular arrhythmias appear to be temporary.
Background:
Although psychological stress is known to favor ventricular arrhythmic events, there is no evidence that stress management intervention decreases ventricular electrical instability in implantable cardioverter-defibrillator (ICD) patients. The aim of the study was to determine whether cognitive behavioral therapy (CBT) results in a decrease of arrhythmic events requiring ICD intervention through an improvement in sympathovagal balance.
Methods:
Of 253 consecutive ICD patients (age 59 +/- 10 years, 64 men), 70 were randomly assigned to CBT (n = 35) or conventional medical care (n = 35). Measures of heart rate variability, psychological well-being, and quality of life were assessed at baseline, 3 months, and 1 year. The primary outcome was appropriate ICD shock.
Results:
Although, it was not statistically different, the number of patients requiring shocks was less in the CBT group than in the conventional treatment group. At 3 months, among patients without antiarrhythmic drugs, none of the subjects in the CBT group had experienced arrhythmic events requiring ICD intervention, as compared with 4 in the control group (P < .05). At 12 months, there was no difference in the number of arrhythmic events requiring therapy between the CBT group versus the control group. Among heart rate variability indexes, daytime pNN 50 and nocturnal SDNN improved significantly in the CBT group, as compared with the control group.
Conclusions:
By decreasing anxiety and possibly improving sympathovagal balance, cognitive behavior therapy may decrease the propensity for ventricular arrhythmias in ICD patients. However, these effects appear to be limited over time.
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