The association between acute mental stress and abnormal left atrial electrophysiology

• Authors: Wesley T. O'Neal, Emory University; Muhammad Hammadah, Emory University; Pratik B. Sandesara, Emory University; Zakaria Almuwaqqat, Emory University; Ayman Samman-Tahhan, Emory University; Mohamad M. Gafeer, Emory University; Naser Abdelhadi, Emory University; Kobina Wilmot, Emory University; Ibhar Al Mheid, Emory University; Douglas J. Bremner, Emory University; Michael Kutner, Emory University; Elsayed Z. Soliman, Wake Forest School of Medicine; Amit Shah, Emory University; Arshed Quyyumi, Emory University; Laura Vaccarino, Emory University
• Journal Title: Journal of Cardiovascular Electrophysiology
• Volume: Volume 28, Number 10
• Publisher: Wiley: 12 months | 2017-10-01, Pages 1151-1157
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1111/jce.13295
• Subjects: Psychology, Clinical
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; arrhythmia; electrocardiogram; electrophysiology; left atrial abnormality; mental stress; FOR-COMPUTERIZED-ELECTROCARDIOLOGY; OF-CARDIOLOGY-FOUNDATION; HEART-RHYTHM-SOCIETY; ATHEROSCLEROSIS RISK; ARRHYTHMIAS COMMITTEE; SCIENTIFIC STATEMENT; CLINICAL CARDIOLOGY; ISCHEMIC-STROKE; FIBRILLATION; COMMUNITIES

Abstract

Background: Acute stress may trigger atrial fibrillation (AF), but the underlying mechanisms are unclear. We examined if acute mental stress results in abnormal left atrial electrophysiology as detected by more negative deflection of P-wave terminal force in lead V1(PTFV1), a well-known marker of AF risk. Methods and results: We examined this hypothesis in 422 patients (mean age = 56 ± 10 years; 61% men; 44% white) with stable coronary heart disease who underwent mental (speech task) stress testing. PTFV1was defined as the duration (milliseconds) times the value of the depth (μV) of the downward deflection (terminal portion) of the P-wave in lead V1measured on digital electrocardiograms (ECG). Electrocardiographic left atrial abnormality was defined as PTFV1≤ −4000 μV*ms. Mean PTFV1values during stress and recovery were compared with rest. The percentage of participants who developed left atrial abnormality during stress and recovery was compared with the percentage at rest. Compared with rest, PTFV1became more negative during mental stress (mean change = −348, 95% CI = [−515, −182]; P < 0.001) and no change was observed at recovery (mean change = 12, 95%CI = [−148, 172]; P = 0.89). A larger percentage of participants showed left atrial abnormality on ECGs obtained at stress (n = 163, 39%) and recovery (n = 142, 34%) compared with rest (n = 127, 30%). Conclusion: Acute mental stress alters left atrial electrophysiology, suggesting that stressful situations promote adverse transient electrical changes to provide the necessary substrate for AF.