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European Heart Journal 2000 21(12):1023-1028; doi:10.1053/euhj.1999.1939
Copyright © 2000 by the European Society of Cardiology.
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Acute psychological stress and the propensity to ventricular arrhythmias. Evidence for a linking mechanism

P.R Jamesa, P Taggarta, S.T McNallyb, S.P Newmanb, S.C Sportona and S.M.C Hardmana,f1

a Departments of Academic and Clinical Cardiology, University College London Medical School and UCL Hospitals, London, U.K.
b Health Psychology Unit, Department of Psychiatry and Behavioural Sciences, University College London Medical School, London, U.K.

revised September 21, 1999; accepted October 1, 1999

Abstract

Aims This study was designed to test the hypothesis that acute psychological stress is capable of inducing an increase in the dispersion of repolarization in patients with underlying coronary artery disease.

Methods and Results Twenty four patients undergoing elective coronary angiography were studied, 17 with significant coronary artery disease and seven with normal coronary arteries. Following coronary angiography they were subjected to a series of timed cognitive tests, well known to induce acute psychological stress. An individual's perception of stress was assessed by visual analogue scales. Serial ECGs were recorded during the cognitive tests and QT, QRS and JT intervals measured from which QT, QRS and JT dispersion were calculated. Psychological stress was reported by the seven patients with normal coronaries and 14 of the 17 with coronary artery disease. In patients who experienced stress a marked increase in QT dispersion, reflecting JT dispersion, was observed in those with coronary artery disease (F=22·4,P =0·0001) but not in those without. At baseline there was no difference in QT dispersion between those with and without coronary artery disease (27–57ms, 17–53ms,P ≥0·5).

Conclusion Acute psychological stress induces an increase in QT dispersion in patients with underlying coronary artery disease due to changes in JT dispersion (rather than QRS dispersion). This suggests that psychological stress modifies the dispersion of repolarization through ischaemia related changes in action potential duration.

Key Words: Dispersion of repolarization, QT dispersion, QRS dispersion, JT dispersion, acute psychological stress, coronary artery disease

f1 Correspondence: Dr S. M. C. Hardman, University College London Medical School (Whittington Campus), Clinical and Academic Department of Cardiovascular Medicine, St. Mary's Wing, Whittington Hospital, Highgate Hill, London N19 5NF, U.K.

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