Beta blockers can block the effects of stress and anger in patients prone to emotion-triggered atrial fibrillation

For patients taking beta blockers, experiencing anger or psychological stress was much less likely to be followed by atrial fibrillation, according to a new study in HeartRhythm


Philadelphia, June 4, 2019

Individuals who are prone to emotion-triggered atrial fibrillation (AF) may benefit from taking beta blockers. A new study shows that beta blockers can block the effects of psychological stress and anger in individuals prone to AF, reports HeartRhythm, the official journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, published by Elsevier.

AF is an irregular, rapid heart rate that may cause symptoms like 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 a previous research study, we found that among patients with a history of AF, anger and stress were associated with subsequent episodes of AF,” explained lead investigator Rachel Lampert, MD, FHRS, Professor of Internal Medicine (Cardiology), Yale School of Medicine, New Haven, CT, USA. “We therefore tested the hypothesis that beta blockers may reduce the triggering effect of anger or stress on AF.”

“Psychological stress increases sympathetic activity and decreases vagal activity,” added Matthew M. Burg, PhD, a clinical psychologist and Associate Clinical Professor of Medicine in the Section of Cardiovascular Medicine at Yale School of Medicine, New Haven, CT, USA. “Catecholamines increase and heart rate variability decreases with anger-recall and other stress-inducing laboratory protocols, which in turn alter electrophysiological properties of the atrium, likely pathways from stress to AF.”

In this prospective controlled study, patients with a history of AF were identified through chart review of individuals undergoing cardioversion and/or diagnosed with AF at the Emergency Departments at Yale New Haven Hospital and The Hospital of Saint Raphael between October 2004 and August 2008. Among these 1,477 patients, 188 patients met inclusion criteria and 95 chose to participate in the study, which was conducted from 2004 to 2009.

Participants carried an electronic diary with them for a year and recorded the emotions they experienced before AF episodes, as well as captured their heart rhythm on a handheld monitor whenever they developed symptomatic AF for five or more minutes. They were also asked to record their emotions while wearing 24-hour ambulatory ECG (Holter) monitors once a month. The emotional recordings during normal rhythm while wearing the 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 experienced anger and stress as often as those not taking these medications, however, these emotional episodes increased the odds of AF by just four times compared with 20 times in those not taking beta blockers. In participants taking beta blockers not including anti-arrhythmic properties the effect was even stronger, completely blocking the pro-arrhythmic effect of anger or stress.

Illustration showing the impact of beta blockers on precipitation of AF by anger or stress. A table and two simulated EKGs are shown.
Impact of beta blockers on precipitation of AF by anger or stress. As seen in the graph, anger or stress increased the odds of AF by 20 times in those not taking beta blockers, but by just four times in those taking beta blockers. If only beta blockers not including anti-arrhythmic properties were evaluated, (i.e., excluding sotalol), the effect was even stronger, completely blocking the pro-arrhythmic effect of anger or stress.

“While patients often describe anger or stress triggering their emotions, our data show that this is more than just anecdote. Here, we show that beta blockers can block the deleterious effects of emotion in those prone to emotion-triggered AF,” commented Dr. Lampert. “Treatment of AF remains challenging. While ablation can be curative for some patients, we do not have a therapy that works for all. 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.”

Beta blockers are a class of medicines that block the effect of beta-adrenergic substances, such as adrenaline (epinephrine), that play a key role in the sympathetic portion 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 the blood vessels in the brain.

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Notes for editors
The article is “Effect of beta-blockers on triggering of symptomatic atrial fibrillation by anger or stress,” by Rachel Lampert, MD, FHRS, Matthew M. Burg, PhD, Larry D. Jamner, PhD, James Dziura, PhD, Cynthia Brandt, MD, Fangyong Li, MPH, Theresa Donovan, BS, and Robert Soufer, MD (https://doi.org/10.1016/j.hrthm.2019.03.004). It appears in HeartRhythm, volume 16, issue 8 (August 2019) published by Elsevier.

This work was supported by the National Institutes of Health (NHLBI grant# R01 HL073285).

Full text of this article is available to credentialed journalists upon request; contact Jane Grochowski at +1 406 542 8397 or hmsmedia@elsevier.com. Journalists who wish to interview the authors should contact Ziba Kashef, Senior Communications Officer for Science and Medicine, Office of Public Affairs and Communications, Yale University, at +1 203 436 9317 or ziba.kashef@yale.edu.

About HeartRhythm
HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability. It integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. www.heartrhythmjournal.com

About the Heart Rhythm Society
The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal healthcare policies and standards. The Heart Rhythm Society is the preeminent professional group representing more than 5,100 specialists in cardiac pacing and electrophysiology from more than 70 countries. www.HRSonline.org

About Elsevier
Elsevier is a global information analytics business that helps scientists and clinicians to find new answers, reshape human knowledge, and tackle the most urgent human crises. For 140 years, we have partnered with the research world to curate and verify scientific knowledge. Today, we’re committed to bringing that rigor to a new generation of platforms. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, 39,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX Group, a global provider of information and analytics for professionals and business customers across industries. www.elsevier.com

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