Volume 13, Issue 1, Pages (January 2016)

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Volume 13, Issue 1, Pages 175-182 (January 2016) Effect of mental stress on dynamic electrophysiological properties of the endocardium and epicardium in humans Malcolm C. Finlay, MRCP, PhD, Pier D. Lambiase, PhD, FHRS, FRCP, Ron Ben-Simon, MD, FRCP, Peter Taggart, DSc, FRCP Heart Rhythm Volume 13, Issue 1, Pages 175-182 (January 2016) DOI: 10.1016/j.hrthm.2015.08.011 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Heart Rhythm 2016 13, 175-182DOI: (10.1016/j.hrthm.2015.08.011) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 Catheter positions for in vivo studies. Schematic (A) and x-ray fluoroscopy (B) catheter positions are shown. endo = endocardial; epi = epicardial; LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle. Heart Rhythm 2016 13, 175-182DOI: (10.1016/j.hrthm.2015.08.011) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 Activation-recovery interval (ARI) reductions during mental stress. A box plot of the change in ARI as compared to the mean ARI during steady-state pacing in the active relaxation protocol is shown. Light boxes indicate data acquired during relaxation, and dark boxes indicate ARI during mental stress. Asterisk represents P < .001 (analysis of variance multilevel regression). A significant reduction in ARI during mental stress was observed in all 3 measurement locations. Epi = epicardial; LV = left ventricular endocardium; RV = right ventricular endocardium. Heart Rhythm 2016 13, 175-182DOI: (10.1016/j.hrthm.2015.08.011) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 3 Example of dynamic activation recovery interval (ARI) restitution curve taken from the left ventricular endocardium. A single electrical restitution curve taken from the left ventricular endocardium is shown. During stress, shorter ARIs are achieved along the entire restitution curve. This is particularly evident at very short diastolic intervals, where ARIs are markedly shorter than during active relaxation. Heart Rhythm 2016 13, 175-182DOI: (10.1016/j.hrthm.2015.08.011) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 4 Dispersion of repolarization. The dynamics of total dispersion of repolarization obtained in 12 patients are shown, normalized to mean dispersion during steady-state pacing during active relaxation. Pacing interval (PI) is normalized to milliseconds above the effective refractory period (ERP). The shaded bands represent 95% confidence intervals, calculated using LOESS (LOcal regrESSion) regression, and separation of these bands implies statistical significance. There is a significant increase in the dispersion of repolarization during stress as pacing intervals approach effective refractory period during stress, which is not present at rest (P < .001; see Table 2). Representative data from 1 patient are shown in the inset. Heart Rhythm 2016 13, 175-182DOI: (10.1016/j.hrthm.2015.08.011) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 5 Arrhythmia induced during mental stress protocol. During the anger recall portion of the mental stress protocol in 1 patient, delivery of 1 programmed stimulus (S2) to the right ventricle induced 1.5 seconds of rapid polymorphic ventricular tachycardia. No arrhythmia had been induced in this patient during programmed stimulation performed in the relaxation state. Heart Rhythm 2016 13, 175-182DOI: (10.1016/j.hrthm.2015.08.011) Copyright © 2016 Heart Rhythm Society Terms and Conditions