Cited by 110Cardiac Health and Mental HealthCardiac pacing and defibrillation studiesCardiac electrophysiology and arrhythmias

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Risk of Ventricular Arrhythmia After Implantable Defibrillator Treatment in Anxious Type D Patients

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van den Broek, Krista C., Nyklíček, Ivan, van der Voort, Pepijn H., Alings, Marco, Meijer, Albert, Denollet, Johan·2009·Journal of the American College of Cardiology

DOI 10.1016/j.jacc.2009.04.043

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Abstract

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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BackgroundResult
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Self-citation
The distressed (Type D) personality in both patients and partners enhances the risk of emotional distress in patients with an implantable cardioverter defibrillator
van den Broek, K. C., Versteeg, H., Erdman, R. A. M., & Pedersen, S. S. (2010) · Journal of Affective Disorders · doi:10.1016/j.jad.2010.10.044 · Cited by 18
Depression and Anxiety as a Risk Factor for Myocardial Infarction
Mal, K., Awan, I., Ram, J., & Shaukat, F. (2019) · Cureus · doi:10.7759/cureus.6064 · Cited by 23
Trajectories of Perceived Emotional and Physical Distress in Patients with an Implantable Cardioverter Defibrillator
van den Broek, K. C., Kupper, N. H. M., van der Voort, P. H., Alings, M., Denollet, J., & Nyklíček, I. (2012) · International Journal of Behavioral Medicine · doi:10.1007/s12529-012-9275-9 · Cited by 16
“Because Type D personality was the strongest predictor for distress, has been related to distress and morbidity and mortality in other studies [19, 27], and can be assessed easily using the brief DS14 scale with clear cutoff scores [28], it may be argued that screening for Type D personality may be most feasible and e…”
BackgroundSelf-citation
Prevalence of anxiety and risk associated with ventricular arrhythmia in patients with an implantable cardioverter defibrillator
Habibović, M., Pedersen, S. S., Broers, E., Alings, M., Theuns, D. A. M. J., van der Voort, P. H., Bouwels, L., HERRMAN, J. P., & Denollet, J. (2020) · International Journal of Cardiology · doi:10.1016/j.ijcard.2020.02.005 · Cited by 17
Self-citation
The distressed (Type D) personality
Pedersen, S. S., & Schiffer, A. A. (2011) · Herzschrittmachertherapie + Elektrophysiologie · doi:10.1007/s00399-011-0139-9 · Cited by 16
Relation between emotional distress and heart rate variability in patients with an implantable cardioverter‐defibrillator
Hoogwegt, M. T., Pedersen, S. S., Theuns, D. A. M. J., & Kupper, N. H. M. (2013) · Psychophysiology · doi:10.1111/psyp.12158 · Cited by 15
Psychological Intervention to Modify Anxiety, Depression and Quality of Life in Patients with an Implantable Pacemaker
Figueroa, C., Alcocer, L. A., & Ramos, B. (2016) · Psychology · doi:10.4236/psych.2016.73040 · Cited by 14
Interventions in the Context of the Distressed (Type D) Personality
Pelle, A. J. M., van den Broek, K. C., & Denollet, J. (2012) · Springer eBooks · doi:10.1007/978-1-4419-5650-7_9 · Cited by 13
Self-citation
Beta-blocker therapy is not associated with symptoms of depression and anxiety in patients receiving an implantable cardioverter-defibrillator
Hoogwegt, M. T., Kupper, N. H. M., Theuns, D. A. M. J., Jordaens, L. J. L. M., & Pedersen, S. S. (2011) · EP Europace · doi:10.1093/europace/eur295 · Cited by 13
Prospective survey of implantable defibrillator shock anxiety in Japanese patients: Results from the DEF‐Chiba study
Miyazawa, K., Kondo, Y., Ueda, M., Kajiyama, T., Nakano, M., Inagaki, M., SCHWAB, J. O., Sears, S. F., & Kobayashi, Y. (2018) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.13442 · Cited by 12
Sigma-1 receptor ligands improves ventricular repolarization-related ion remodeling in rats with major depression disorder
Guo, Y., Zhang, C., Chen, X.-H., Liu, X., Ye, T.-X., Fo, Y., Shi, S.-B., Qu, C., Liang, J.-J., Shen, B., et al. (2020) · Psychopharmacology · doi:10.1007/s00213-020-05697-4 · Cited by 11
Does Type D Personality Impact on the Prognosis of Patients Who Underwent Catheter Ablation for Atrial Fibrillation? A 1-Year Follow-Up Study
Jeon, S. W., Lim, H. E., Yoon, S., Na, K. S., Ko, Y., Joe, S.-H., & Kim, Y. (2017) · Psychiatry Investigation · doi:10.4306/pi.2017.14.3.281 · Cited by 12
Anxiety, a significant risk factor for coronary artery disease: what is the best index
Rezaee, M., Darroudi, H., Etemad, L., Shad, A. N., Zardast, Z., Kohansal, H., Ghayour‐Mobarhan, M., Sadeghian, F., Moohebati, M., Esmaily, H., et al. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-05798-w · Cited by 8
“Various potential processes have been suggested to provide a reliable prediction for the correlation between anxiety disorders and CAD including cardiac arrhythmias [39], attenuated heart rate variability [40], and atherosclerosis development [30].”
Background
Psychische Komorbidität und Lebensqualität bei Patienten mit implantierbarem Kardioverter/Defibrillator (ICD)
Ladwig, K., Ronel, J., Baumert, J. J., & Kolb, C. (2010) · Herzschrittmachertherapie + Elektrophysiologie · doi:10.1007/s00399-010-0082-1 · Cited by 7
Impact of the COVID‐19 lockdown on the arrhythmic burden of patients with implantable cardioverter‐defibrillators
Sassone, B., Virzì, S., Bertini, M., Pasanisi, G., Manzoli, L., MYERS, J. N., Grazzi, G., & Muser, D. (2021) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.14280 · Cited by 8
Anxiety and Depression: Risk Factors for Cardiovascular Disease
Compare, A., Proietti, R., Germani, E., & Janeway, D. (2012) · Springer eBooks · doi:10.1007/978-1-4419-5650-7_8 · Cited by 7
Post-traumatic stress disorder, emotional processing and Inappropriate Implantable Cardioverter-Defibrillator Shocks: clinical consideration by a single case report
Compare, A., Forno, D. D., Callus, E., Giallauria, F., Vitelli, A., Buccelli, C., & Vigorito, C. (2015) · Monaldi Archives for Chest Disease · doi:10.4081/monaldi.2012.122 · Cited by 6
Post‐traumatic stress disorder and its risk factors in Japanese patients living with implantable cardioverter defibrillators: A preliminary examination
Kobayashi, S., Nishimura, K., Suzuki, T., Shiga, T., & Ishigooka, J. (2013) · Journal of Arrhythmia · doi:10.1016/j.joa.2013.07.004 · Cited by 6
“As state anxiety is characterized as a temporary change in a patient's emotional state due to medical illness or other external cause and because state anxiety has previously been used in clinical studies on cardiovascular disease [25,26], only the state scale measurement was used in this study.”
Method
Association of type-D personality and left-ventricular remodelling in patients treated with primary percutaneous intervention after ST-segment elevation myocardial infarction
Zia-ul-Sabah, Alqahtani, S. A. M., Alghamdi, B. H., Wani, J. I., Aziz, S., Durrani, H. K., Patel, A. A., Rangraze, I. R., & Wani, S. J. (2024) · BMC Cardiovascular Disorders · doi:10.1186/s12872-024-04254-7 · Cited by 4
“…a strong association between type-D personality traits and various cardiovascular conditions, including coronary artery disease (CAD) [5, 6], peripheral artery disease (PAD) [7], cardiac arryth-mia [8], congestive heart-failure (CHF) [9], and a 4-fold risk of developing ischaemic heart disease [6].”
Background
ICD surgery: highlighting the psychological consequences
Jackson, A. C., & Murphy, B. M. (2017) · British Journal of Cardiac Nursing · doi:10.12968/bjca.2017.12.10.482 · Cited by 4
Personality traits, ventricular tachyarrhythmias, and mortality in patients with an implantable cardioverter defibrillator: 6 years follow-up of the WEBCARE cohort
Broers, E., Habibović, M., Denollet, J., Widdershoven, J. W. M. G., Alings, M., Theuns, D. A. M. J., van der Voort, P., Bouwels, L., HERRMAN, J. P., & Pedersen, S. S. (2019) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2019.11.009 · Cited by 4
“Moreover, previous research has shown that the combination of Type D personality and anxiety or concerns about ICD treatment increases the risk of mortality [12] or VTa's [34], suggesting a possible cumulative effect of co-existing emotional and personality factors and that psychosocial risk factors often cluster toge…”
Self-citation
Cardiac Arrhythmias and Sudden Cardiac Death
Whang, W., & Burg, M. M. (2022) · Springer eBooks · doi:10.1007/978-0-387-85960-6_48 · Cited by 4
Perfil psicossocial de portadores de CDI: COMFORT-CDI
Guimarães, T. B. (2016) · doi:10.11606/t.5.2016.tde-24102016-154635 · Cited by 4
Personality Factors in Cardiovascular Disease: The Big Five and Type D Personality
Versteeg, H., Schiffer, A. A., & Pedersen, S. S. (2022) · Springer eBooks · doi:10.1007/978-0-387-85960-6_19 · Cited by 6
Device nurse intervention facilitates the patients’ adaptation to cardiac shock devices in the remote monitoring era
Ogawa, T., Saito, N., Fukuzawa, K., Kiuchi, K., Takami, M., Hayashi, M., Tanioka, R., Ota, M., Komoriya, K., Miyawaki, I., et al. (2021) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.14348 · Cited by 3
Assessment of Cardiac Autonomic Functions in Medical Students With Type D Personality
Narasimhan, S. (2016) · JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH · doi:10.7860/jcdr/2016/17516.7214 · Cited by 3
Significance of Neuropeptides for Coexistence of Disturbances in Central Cardiovascular Control in Heart Failure, Stress and Depression
Szczepanska‐Sadowska, E. K. (2014) · Journal of Clinical & Experimental Cardiology · doi:10.4172/2155-9880.1000313 · Cited by 3
“Recent studies performed on patients with heart failure revealed an elevated risk of ventricular arrhythmia and mortality in infarcted patients with type D (distressed) personality [106,114,115].”
Background
Depression and Heart Disease: Uncracked Mystery of the Chicken and the Egg
Pedersen, S. S. (2010) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.2010.02929.x · Cited by 3
Quality of life with a cardioverter defibrillator
Eftekhari, H., & Osman, F. (2013) · British Journal of Cardiac Nursing · doi:10.12968/bjca.2013.8.7.345 · Cited by 2
Validity of the newly developed 4-item ANXiety-scale in patients with an implantable cardioverter defibrillator: A 12-month follow-up study
Denollet, J., Pedersen, S. S., Warnaars, F. E., & Habibović, M. (2020) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2020.110106 · Cited by 3
Self-citation
Increased Dispersion of Ventricular Repolarization as an Arrhythmic Risk Marker in Drug-free Patients With Major Depressive Disorder: A Preliminary Comparative Study
Balcıoğlu, Y. H., Gökçay, H., Balcioglu, S. S. K., & Solmaz, M. (2023) · Journal of Psychiatric Practice · doi:10.1097/pra.0000000000000721 · Cited by 2
State of the art of ICD programming: Lessons learned and future directions
Mastenbroek, M. H., Pedersen, S. S., Versteeg, H., Doevendans, P. A., & Meine, M. (2014) · Netherlands Heart Journal · doi:10.1007/s12471-014-0582-4 · Cited by 2
Stress e personalidade: overview e avaliação crítica de revisões sistemáticas sobre padrão comportamental tipo a e personalidade tipo d com desfechos coronarianos
Urso, J. (2011) · Digital Library of Theses and Dissertations (Universidade de São Paulo) · doi:10.11606/t.47.2011.tde-30112011-103946 · Cited by 2
Cardiovascular Implantable Electronic Devices
Logan, J., & Boushahri, A. (2016) · Hospital Medicine Clinics · doi:10.1016/j.ehmc.2016.07.001 · Cited by 1
Depression and Risk of Sudden Cardiac Death and Arrhythmias: A Systematic Review and Meta-Analysis
You, Y., Shi, Y., Yu, Q., Rao, X., Tong, X., Tang, T., Hu, S., Zhang, S., Zhang, X., Wang, H., et al. (2025) · Reviews in Cardiovascular Medicine · doi:10.31083/rcm36520 · Cited by 1
“A total of 17 studies [13–21,24”
Osobowość typu D i choroba sercowo-naczyniowa: przegląd literatury
Minasidou, E., Kafkia, T., Dimitriadou, A., Kallia, T., & Κourakos, M. (2017) · Innowacje w Pielęgniarstwie · doi:10.21784/iwp.2017.012 · Cited by 1
“It seems that it is associated with increased morbidity [37], poor quality of life [37], poor prognosis and mortality [38] in patients with cardiovascular diseases [28,39,40].”
Background
Psychosocial Concerns in Patients Living with an Implantable Cardioverter Defibrillator
Thylén, I. (2017) · Springer eBooks · doi:10.1007/978-3-319-55721-2_3 · Cited by 1
Psychometric Testing of the Emotional Responses Post Implantable Cardioverter Defibrillator Scale
Conelius, J. (2017) · Journal of Nursing Measurement · doi:10.1891/1061-3749.25.2.305 · Cited by 1
Establishing a Standard for Peri-operative ICD Education : A Demonstration Project
Kirian, K. (2012) · ProQuest Demo Repository · Cited by 1
Psychiatric Aspects of Sudden Cardiac Arrest and Implantable Cardioverter‐Defibrillators
Ravindranath, D., & Pelosi, F. (2011) · doi:10.1002/9780470975138.ch6 · Cited by 1
Highlights of the Year in JACC2009
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“(83) examined the ombination of anxiety, depression, and distressed or type D ersonality as predictors for ventricular arrhythmias in atients with ICDs.”
Anxiety and Heart Disease
Harlapur, M., & Shimbo, D. (2020) · Springer eBooks · doi:10.1007/978-3-030-39903-0_1248 · Cited by 1
Arrhythmogenic Right Ventricular Cardiomyopathy: From Surviving to Thriving
Cory, J. S. (2015) · Scholarly Commons (University of Pennsylvania)
Type D personality across general population and coronary patient samples in Iceland : Implications for cardiovascular health
Svansdóttir, E. (2012) · Research portal (Tilburg University)

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)
ORCID: Nyklíček, Ivan
Alings, Marco
Denollet, Johan
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)
DOI: 10.1016/j.jacc.2009.04.043
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: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 1482 d)
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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Risk of Ventricular Arrhythmia After Implantable Defibrillator Treatment in Anxious Type D Patients

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