AF Caused by Stress, Anger Can Be Abated With β-Blockers
Individuals who are more likely to experience atrial fibrillation (AF) after being stressed or angered can minimize the effects by taking β-blockers, results of a new study demonstrate.1
To determine whether β-blockers could protect against emotionally triggered AF, the researchers analyzed data from 91 participants with a history of paroxysmal or persistent AF, 56 of whom were prescribed β-blockers.
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The researchers identified the participants for the prospective controlled study by reviewing the charts of individuals undergoing cardioversion and/or were diagnosed with AF at the emergency departments at Yale New Haven Hospital and the Hospital of Saint Raphael between October 2004 and August 2008.2
For 1 year, the participants recorded their heart rhythm on handheld event monitors at the time of AF symptoms, as well as their mood states during the 30 minutes before AF. Once a month, the participants also underwent 24-hour Holter monitoring, during which they had completed 2 diary entries per hour to record their mood.
In all, 34 participants experienced 163 symptomatic AF episodes. Meanwhile, the Holter monitoring recorded 11,563 sinus rhythm control periods.
By analyzing the data, the researchers concluded that an individual was significantly more likely to experience an AF episode during times of anger or stress. However, this association was greatly reduced in participants taking β-blockers. In fact, episodes of stress and anger increased the odds for AF by 20 times in those not taking β-blockers and by 4 times in those who were taking β-blockers.2
The effect was even stronger in participants who were taking β-blockers that did not include anti-arrhythmic properties; these medications completely blocked the pro-arrhythmic effect of anger or stress.2
“Treatment of AF remains challenging. While ablation can be curative for some patients, we do not have a therapy that works for all,” said lead investigator, Rachel Lampert, MD, a professor of internal medicine (cardiology) at Yale School of Medicine, in a press release. “Thus, for many, managing AF symptoms is imperative for quality of life. Confirming the impact of emotion on arrhythmia can point the way to further therapies."2
—Colleen Murphy
References:
1. Lampert R, Burg MM, Jamner LD, et al. Effect of β-blockers on triggering of symptomatic atrial fibrillation by anger or stress [published online June 3, 2019]. Heart Rhythm. https://doi.org/10.1016/j.hrthm.2019.03.004.
2. Beta blockers can block the effects of stress and anger in patients prone to emotion-triggered atrial fibrillation [press release]. Philadelphia, PA: Elsevier; June 4, 2019. https://www.elsevier.com/about/press-releases/research-and-journals/beta-blockers-can-block-the-effects-of-stress-and-anger-in-patients-prone-to-emotion-triggered-atrial-fibrillation. Accessed June 4, 2019.