Fine-Tuning a Heart-Brain Connection
Anxiety in Atrial Fibrillation
The field of behavioral cardiology has detailed various associations that exist between the heart and the brain. Studies have evolved from the Type A personality in the 1970s, to the landmark study of depression increasing mortality in the post–myocardial infarction setting in the 1990s,1 to the new wave of anxiety studies in the past couple of years that have shown anxiety to be a risk factor for development of coronary artery disease as well as being cardiotoxic in established heart disease.2 Even though the mechanistic pathways as to why these associations occur still elude us, the impact of personality traits, depression, and anxiety on heart disease is undeniable.
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Emotions have also been strongly associated with arrhythmias as a whole. In earthquake scenarios, sudden increases in cardiovascular deaths are known to occur,3 and cardiovascular events increase in presumably more “benign” scenarios, such as World Cup Soccer matches.4 Transient cardiac dysfunction has been well described with strong emotional events, referred to as Tako-tsubo cardiomyopathy.5 Implantable cardioverter-defibrillator patients who demonstrate anger-induced T-wave alternans during mental stress are at higher risk for ventricular arrhythmias, prompting further interventional studies and the editorial article, “Anger Management May Save Your Life.”6
Clinically, atrial fibrillation is the most common cardiac arrhythmia and can cause in some patients psychological distress and a negative impact on quality of life.7 “Doc, I know I have heart disease, but if you can fix this afib, I know I will …