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Phobic Anxiety, Depression, and Risk of Ventricular Arrhythmias in Patients With Coronary Heart Disease

From the Departments of Psychiatry and Behavioral Sciences (L.L.W., J.A.B., J.R.T.D., M.A.B.) and Medicine (C.B.M., M.H.S.), Duke University, Durham, North Carolina.

Address correspondence and reprint requests to Lana L. Watkins, PhD, Department of Psychiatry and Behavioral Sciences, Box 3119, Duke Medical Center, Durham, NC 27710. E-mail: watki017{at}mc.duke.edu

Objective: Findings of an association between phobic anxiety and elevated risks of sudden cardiac death suggest that phobic anxiety may be related to increased risk of ventricular arrhythmias. The purpose of this study was to examine whether phobic anxiety is associated with ventricular arrhythmias in patients with documented coronary artery disease (CAD).

Methods: Phobic anxiety level was measured using the Crown-Crisp phobic anxiety scale in 940 patients (660 men, 280 women) hospitalized for diagnostic cardiac catheterization between April 1999 and June 2002. Depressive symptomatology was assessed using the Beck Depression Inventory. Patients were followed for a median follow-up period of 3 years, and the occurrence of ventricular arrhythmias was determined through review of medical records.

Results: Ventricular arrhythmias occurred in 97 patients and were significantly related to higher phobic anxiety after statistical adjustment for established medical and demographic determinants of arrhythmias (odds ratio = 1.40; p = .012). Depressive symptomatology was significantly correlated with phobic anxiety (r = 0.44, p < .001) and was also related to ventricular arrhythmias (odds ratio = 1.40; p = .006). The composite of depression and phobic anxiety predicted ventricular arrhythmias with a larger effect size than either depression or phobic anxiety score alone (odds ratio = 1.6, 95% confidence interval, 1.2–2.1, p = .002).

Conclusions: Both phobic anxiety and depressive symptomatology predict ventricular arrhythmias in patients with CAD and may share a common factor predictive of ventricular arrhythmias.

Key Words: phobic anxiety • coronary disease • sudden death • arrhythmias

Abbreviations: CAD = coronary artery disease; SCD = sudden cardiac death; MI = myocardial infarction; LVEF = left ventricular ejection fraction; BDI = Beck Depression Inventory; NSVT = nonsustained ventricular tachycardia; susVT = sustained ventricular tachycardia; V-fib = ventricular fibrillation; BMI = body mass index; ICD = internal cardiodefibrillator device.

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