Biobehavioral Triggers of Cardiac Arrhythmia during Daily Life: The Role of Emotion, Physical Activity, and Heart Rate Variability

摘要

Biobehavioral factors, such as physical activity and emotions, have been associated with adverse cardiac outcomes, including myocardial ischemia and infarction, in individuals with coronary artery disease. However, cardiac arrhythmia has largely been neglected with regard to psychosocial influences. This study examined the role of physical activity and acute emotions in triggering arrhythmia in susceptible individuals during everyday activities. In addition, it addressed the impact of chronic factors, including trait anxiety, hostility, depression, and usual levels of physical activity on arrhythmia. Finally, the study explored short-term and long-term heart rate variability (HRV) as a potential mechanism for the impact of biobehavioral factors on cardiac arrhythmia. Participants included 40 men and 10 women with documented coronary artery disease who had received implantable cardioverter defibrillators (ICDs). As part of the Triggers of Arrhythmia in Defibrillator Patients (TRIAD) study, these individuals were monitored for 48 hours using ambulatory electrocardiogram (ECG) recorders. During the monitoring period, participants completed two structured diaries, recording their activities and moods. Participants also completed standardized measures of depression, hostility, and trait anxiety. Ambulatory ECG tapes were analyzed to identify arrhythmic events, and these events were correlated with changes in physical activity and/or emotions to identify acute triggers of arrhythmia. Acute changes in HRV immediately coincident and following these triggers were evaluated. As predicted, higher levels of trait anxiety and chronic depressive symptoms were associated with lower measures of heart rate variability. Although all associations between hostility and HRV were negative (i.e., higher hostility was associated with lower HRV), the associations were small and did not reach statistical significance.