MedWire News: Patients with anxiety and a Type D personality are at increased risk for ventricular arrhythmias in the first year after receiving an implantable cardioverter defibrillator (ICD).
“Clustering of increased anxiety at the time of implantation and having a Type D personality predicted arrhythmia, with its 1.7-fold independent risk being comparable with the 1.9-fold risk for secondary prevention patients,” report Krista van den Broek (Tilburg University, The Netherlands) and colleagues.
The researchers examined the extent to which Type D personality may modulate the association between anxiety/depression and ventricular arrhythmia in the first year after ICD implantation.
“Previously, we have argued that research should focus on the interaction of psychological factors and we have shown that clustering of Type D personality with other psychological factors increases the risk of adverse outcomes,” they explain.
The study included 391 patients who underwent ICD implantation between May 2003 and December 2006 (81% men, age 62.3 years) and who completed anxiety, depression, and Type D personality scales at the time of implantation.
As reported in the Journal of the American College of Cardiology, ventricular arrhythmias occurred in 75 (19%) patients.
Increased symptoms of depression or anxiety did not predict arrhythmias. However, anxious patients with a Type D personality had a significantly increased rate of ventricular arrhythmias (29.6%) compared with other ICD patients (16.9%), giving a hazard ratio (HR) of 1.89 (p=0.013).
After accounting for gender, age, ischemic etiology, left ventricular dysfunction, prolonged QRS duration, and medication, anxious Type D patients (HR=1.72, p=0.039) and secondary prevention patients (HR=1.91, p=0.014) were at increased risk of ventricular arrhythmias.
“In clinical practice, anxious Type D patients should be identified and offered adequate support,” concludes the team. “Future studies may focus on the prevalence and prognostic value of clustering of psychological risk factors, but also on the role of supportive therapy in these patients. In addition, mechanisms and pathways linking anxiety and personality traits to ventricular arrhythmias need to be studied.”
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