Arrhythmogenic role of mental stress in patients with Wolff-Parkinson-White syndrome

Both acute and chronic forms of psychological stress have been proposed as precipitants of sudden cardiac death in patients with coronary artery disease. However few information has been gained so far, about the effects of acute psychological stress in patients with ventricular preexcitation (WPW). Indeed such evaluation could be relevant to define the individual arrhythmic risk in WPW. In this study 40 patients with WPW syndrome and otherwise normal hearts were investigated, most of them for agonistic sports aptitude assessment. Psychological profiling was carried out with M.H. e., Wartegg, Toulouse-Pieron and Banati-Fischer tests. All conventional EP parameters were quantified, by trans-esophageal pacing, under basal conditions and during 6 minutes of mental stress (a modified colour-word conflict task). The combined effect of mental stress, postural changes and physical effort was evaluated as well. Average ERPs of Kent and AV Node were both shortened by mental stress. This effect however was statistically significant only at rest, in the upright position, at drive cycles of 600, 400 ms (p <0.05) and 320 ms (p <0.01). A proarrhythmic effect was observed in 6 subjects, being AF (3 cases) or AVRT (3 cases) inducible only during mental stress. Psychological profiling evidenced that proarrhythmic modification of electrophysiological parameters induced during mental stress occurred in individuals with a lack of aggressivity integration or blocked psychic energy, which results in a poor ''coping'' capability Conclusions: Individual personality traits and coping style should be evaluated as an independent risk factor, because they could play a pathogenic role for the occurrence of life-threatening arrhythmias in WPW patients, especially when engaged in agonistic sports or risky occupations implying strong emotional involvement