Beta-blockers may block the effects of stress and anger in patients prone to emotionally induced atrial fibrillation

People who are prone to atrial fibrillation (AF) triggered by emotions may benefit from taking beta-blockers. New study shows beta blockers can block the effects of psychological stress and anger in people with AF, reports Heartbeat, the official journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society.

AF is an irregular and fast heart rate that can cause symptoms such as heart palpitations, fatigue and shortness of breath. Like myocardial infarction and ventricular arrhythmias, AF can be triggered by psychological stress and negative emotions such as anger.

"In an earlier study, we found that in patients with a history of AF, anger and stress were associated with subsequent episodes of AF," said lead researcher Rachel Lampert, MD, FHRS, professor of internal medicine. (Cardiology), Yale School of Medicine, New Haven, Connecticut, USA. "So we tested the hypothesis that beta-blockers could reduce the triggering effect of anger or stress on FA."

"Psychological stress increases sympathetic activity and decreases vagal activity," added Matthew M. Burg, Ph.D., clinical psychologist and associate clinical professor of medicine at Yale's Cardiovascular Medicine section. School of Medicine, New Haven, Connecticut, USA. . "Catecholamines increase and the variability of heart rate decreases with laboratory protocols of angry reminder and stress induction, which in turn alter the electrophysiological properties of the atrium, likely pathways of stress. to the FA. "

In this prospective controlled study, patients with a history of AF were identified by a review of the charts of subjects undergoing cardioversion and / or diagnosed with AF at the emergency departments of Yale New Haven and Saint Raphael hospitals between October 2004 and August 2008. Of these 1,477 patients, 188 patients met the inclusion criteria and 95 chose to participate in the study conducted between 2004 and 2009.

Participants took an electronic diary with them for one year and recorded the emotions they had experienced prior to episodes of AF, as well as their heart rate on a portable monitor whenever they developed symptomatic AF. for at least five minutes. They were also asked to record their emotions when they were carrying Ambulatory ambulatory ECG monitors (Holter) once a month. Emotional recordings at normal rhythm while wearing Holter monitors served as controls.

Fifty-six of the participants were prescribed agents with beta-blocking activity. The results showed that patients taking beta-blockers felt anger and stress as often as those who did not take these drugs. However, these emotional episodes increased the odds of FA by only four-fold, compared to 20-fold for those not taking beta-blockers. In participants taking beta-blockers without antiarrhythmic properties, the effect was even more powerful, completely blocking the proarrhythmic effect of anger or stress.

"While patients often describe anger or stress triggering their emotions, our data show that it's not just anecdote." We show here that beta-blockers can block deleterious effects of emotion in those who are subject to AF triggered by emotions, "commented Dr. Lampert. "The treatment of AF remains difficult.While ablation can be curative for some patients, we do not have therapy that works for everyone.So, for many, managing the symptoms of FA is essential for quality of life Confirming the impact of emotion on arrhythmia can point the way to other therapies. "

Beta-blockers are a class of drugs that block the effect of beta-adrenergic substances, such as epinephrine (epinephrine), which play a key role in the sympathetic part of the involuntary nervous system. They temporarily stop or reduce the body's natural "fight or flight" responses and reduce stress on certain parts of the body, such as the heart and blood vessels of the brain.