Prospective diary-based study suggests a strategy for controlling the risk
For paroxysmal and persistent atrial fibrillation (Afib, AF) patients, symptomatic episodes are much more likely after bouts of stress and anger, although beta-blockers may partially offset this risk, an electronic diary-based study found.
The two negative emotions together contributed to a significantly higher likelihood of an atrial fibrillation episode, especially among patients not prescribed beta-blockers (odds ratio 22.5, P<0.0001) but still substantial among those on beta-blockers (OR 4.0, P=0.002), reported Rachel Lampert, MD, of the Yale School of Medicine in New Haven, Connecticut, and colleagues in Heart Rhythm.
Anger on its own was associated with a 10-fold higher likelihood of an atrial fibrillation episode among those not prescribed beta-blockers but a 4.1-fold higher risk among those prescribed beta-blockers, both statistically significant.
Stress was a somewhat more potent factor, with a 19-fold higher risk of an atrial fibrillation episode among those not prescribed beta-blockers and a 4.6-fold higher risk among those on beta-blockers, the investigators found.
When it comes to clinical practice, "it's important to address with patients what they think their triggers might be. And for people who do identify anger and stress and other negative emotions, I think working with patients to think about ways to counter those affects in their lives is important," Lampert told MedPage Today.
Previous research has also supported a role for negative emotions, like anger or stress, in triggering clinical cardiac events and for beta-blockers in protecting against them, noted Rachel Bond, MD, of Sun State Cardiology in Chandler, Arizona, who was not involved in the study.
"Previous studies have demonstrated that beta-blockers can decrease triggering of other cardiac events, such as morning peak in both sudden death and myocardial infarction, by other sympathetic stimuli driven by circadian variation in autonomic activity which beta-blockers attenuate," Bond told MedPage Today.
Beta-blockers could be targeted to those prone to emotional triggering or to have patients take them during periods of hazard on the basis of known triggers, the researchers wrote.
Such a temporally-targeted approach may help avoid medication side effects, Bond noted.
"Whether beta-blockers use targeted to potential triggers can decrease symptoms is an important avenue for future research," the researchers concluded.
The researchers evaluated 37 patients who were not prescribed beta-blockers and 54 patients who were prescribed beta-blockers with a history of persistent or paroxysmal atrial fibrillation over 1 year. The cohort had a mean age of 59 years and was mostly white.
Participants document their rhythm on event monitors when AF symptoms occurred and filled out a diary entry related to moods like stress and anger for the preceding 30 minutes. Each month, patients were also assessed for 24-hours using Holter monitoring. Diary entries reported during sinus rhythm were used as controls. Patients' exposure to anger and stress was compared between the control periods and pre-AF case period using interactions between the emotion examined and beta-blocker use, along with using generalized estimating equation modeling.
Bond pointed out that the mostly healthy, young, white male cohort limited the generalizability of the study. She also noted that adherence to and dosage of beta-blockers was not measured, which hinders the ability to determine if there is a dose-response association.
"Lastly, as the participants were recruited from those most symptomatic in that they were either undergoing cardioversion or presenting to the emergency department, it is hard to determine if these results can be generalized to less symptomatic patients," Bond continued.
This study was supported by the National Heart, Lung, and Blood Institute, the National Institutes of Health, the National Center for Research Resources, and the National Center for Advancing Translational Science (NCATS).
Bond reported no disclosures.
Source Reference: Lampert R, et al "Effect of b-blockers on triggering of symptomatic atrial fibrillation by anger or stress" Heart Rhythm 2019; DOI: 10.1016/j.hrthm.2019.03.004.
Read the original article on Medpage Today: Stress, Anger Trigger Fewer Afib Episodes With Beta-Blocker Use