Risk of Ventricular Arrhythmia After Implantable Defibrillator Treatment in Anxious Type D Patients
Open accessAbstract
Objectives We sought to examine the combination of adverse psychological factors (anxiety, depression, and distressed or Type D personality) as a predictor of ventricular arrhythmias in patients with implantable cardioverter-defibrillators (ICDs).Background Little is known about the role of psychological factors and their clustering in the occurrence of life-threatening arrhythmias.Methods In this prospective study, 391 patients with an ICD (81% men, age 62.3 +/- 10.4 years) completed anxiety, depression, and Type D personality scales at the time of implantation. The end point was occurrence of ventricular arrhythmia, defined as appropriate ICD therapies, in the first year after implantation.Results Ventricular arrhythmias occurred in 19% (n = 75) of patients. Increased symptoms of depression (p = 0.81) or anxiety (p = 0.31) did not predict arrhythmias. However, anxious patients with a Type D personality had a significantly increased rate of ventricular arrhythmias (21 of 71; 29.6%) as compared with other ICD patients (54 of 320; 16.9%; hazard ratio [HR]: 1.89; 95% confidence interval [CI]: 1.14 to 3.13; p = 0.013). When controlled for the effects of sex, age, ischemic etiology, left ventricular dysfunction, prolonged QRS duration, and medication, anxious Type D patients (HR: 1.72; 95% CI: 1.03 to 2.89; p = 0.039) and secondary prevention patients (HR: 1.91; 95% CI: 1.14 to 3.20; p = 0.014) were at increased risk of ventricular arrhythmias.Conclusions Personality modulated the effect of emotional distress; anxiety predicted a 70% increase in risk of arrhythmia in Type D patients but not in other patients. Anxious Type D patients may be identified and offered additional behavioral support after ICD implantation.
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Anxiety, associated with sympathetic nervous system disturbance, contributes to Type D-related mortality risk.
“Others studies suggest that anxiety, associated with sympathetic nervous system disturbance [152], as well as ineffective interaction with health care providers [153], contributes to Type D-related mortality risk.”
From Personality and Longevity: Knowns, Unknowns, and Implications for Public Health and Personalized Medicine (2011) · cites this paper as [152]
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Self-citationThe distressed (Type D) personality
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- Authors
- van den Broek, K. C., Nyklíček, I., van der Voort, P. H., Alings, M., Meijer, A., & Denollet, J.
- Affiliations
- Tilburg University (NL)
- Amphia Ziekenhuis (NL)
- Catharina Ziekenhuis (NL)
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2009-08
- Volume
- 54
- Issue
- 6
- Pages
- 531-537
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2068137454
- Cited by
- 110
- References
- 58
- Citations by year
- 2025: 2 · 2024: 3 · 2023: 1 · 2022: 4 · 2021: 4 · 2020: 4 · 2019: 4 · 2018: 2 · 2017: 8 · 2016: 7 · 2015: 6 · 2014: 5 · 2013: 11 · 2012: 18
- FWCI
- 10.61
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- Research portal (Tilburg University) (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- Nederlandse Organisatie voor Wetenschappelijk Onderzoek (453-04-004)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- ventricular arrhythmias, implantable cardioverter-defibrillator, Type D personality, anxiety, depression, psychological distress, personality traits, appropriate ICD shocks, secondary prevention, behavioral support
- MeSH terms
- Aged, Anxiety Disorders, Arrhythmias, Cardiac, Depressive Disorder, Female, Humans, Male, Middle Aged, Personality, Risk Factors, Defibrillators, Implantable
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