Abnormal P-wave axis and myocardial ischemia development during mental stress

• Type of Material: Article
• Authors: Zakaria Almuwaqqat, Emory University; Wesley T O'Neal, Emory University; Muhammad Hammadah, Emory University; Bruno B Lima, Emory University; James Bremner, Emory University; Elsayed Z Soliman, Bowman Gray Center for Medical Education; Amit Shah, Emory University; Arshed Quyyumi, Emory University; Laura Vaccarino, Emory University
• Language: English
• Date: 2020-05-01
• Publisher: CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020 Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jelectrocard.2020.02.019
• Title of Journal or Parent Work: JOURNAL OF ELECTROCARDIOLOGY
• Volume: 60
• Start Page: 3
• End Page: 7
• Grant/Funding Information: Research reported in this publication was supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health under the following award numbers: (P01HL101398, R01HL109413, R01HL109413-02S1, R01 HL125246, K24HL077506, K24MH076955, UL1TR000454, KL2TR000455, K23HL127251, TL1TR002382, UL1TR002378, and F32HL134290). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
• Keywords: ASSOCIATION; STROKE; SEX-DIFFERENCES; DISEASE; Cardiovascular System & Cardiology; Ischemia; Cardiac & Cardiovascular Systems; MECHANISMS; Science & Technology; Sex; SYSTEM; Life Sciences & Biomedicine; Atrial fibrillation; Stress; ATRIAL-FIBRILLATION; ARRHYTHMIAS

Abstract

Exposure to psychological stress has been associated with the development of sustained arrhythmias. Acute changes in atrial electrophysiology may serve as intermediate phenotypes for stress-induced atrial arrhythmia such as atrial fibrillation. We examined if acute mental stress was associated with the development of abnormal P-wave axis (aPWA) and the role played by stress-induced myocardial ischemia. A total of 359 patients (mean age = 56 ± 9.9 years; 62% men; 43% white) with stable coronary heart disease and normal baseline P-wave axis (between 0° and 75°) were studied. All patients underwent mental stress testing (speech task). A total of 46 (13%) patients developed abnormal P-wave axis during either stress or recovery (stress: n = 43, 12%; recovery: n = 12, 3%). A rise in heart rate during mental stress was associated with an increased risk of an abnormal P-wave axis (per 5-unit increase: OR = 1.37, 95%CI = 1.03, 1.30). Myocardial ischemia induced by mental stress was associated with an increased risk of aPWA in women (OR = 5.2, 95%CI = 1.7, 15.6) and not in men (OR = 0.1, 95%CI = 0.01, 1.01), p-interaction = 0.004). In conclusion, in a sizable proportion of patients, acute mental stress results in the development of an abnormal P-wave axis, and this phenomenon is related to increases in heart rate and, among women, mental stress-induced ischemia. Our data suggest that acute psychological stress can promote adverse transient electrical changes in the atria that may predispose to AF.