[Psychotherapeutic interventions for reducing stress in patients with cardiac arrhythmias]

Cardiac arrhythmias may remain asymptomatic, but they can also be experienced as palpitations or implantable cardioverter-defibrillator (ICD) shocks that feel existentially threatening. Even harmless arrhythmias can trigger intense anxiety reactions, including traumatic processing. Therefore, in addition to cardiological diagnostics and treatment, an integrative psychocardiological perspective is needed. From a cardiological point of view, the symptom burden should be reduced, for example, by avoiding substances that promote arrhythmias, treating underlying diseases, and-particularly in ICD patients-optimizing potassium levels. Psychoeducation is central: patients should understand why extrasystoles may be experienced as missed beats, strong palpitations, or a sensation of the "heart beating up into the throat." Equally important is discussing the vicious circle of anxiety: tension, worry, and self-monitoring lower the threshold for perception; perceived cardiac symptoms then intensify anxiety and autonomic arousal. Since these signals are interoceptive, avoidance is not possible, and patients should be taught routines that help them break out of the anxiety cycle. Special attention should be given to patients after an ICD shock or cardiac arrest. They may develop posttraumatic stress disorder induced by the cardiac event (CDI-PTSD). Supportive communication, realistic hope, and basic psychosomatic or psychocardiological interventions can reduce nocebo effects and anxiety spirals. In addition, this approach may help identify patients whose need for treatment should be discussed within a "Psycho-Cardio-Team" that still needs to be established.