Psychological factors and cardiac repolarization instability during anger in implantable cardioverter defibrillator patients

David S. Krantz, Kristie M. Harris, Heather L. Rogers*, Kerry S. Whittaker, Mark C.P. Haigney, Willem J. Kop

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: Evidence indicates that emotions such as anger are associated with increased incidence of sudden cardiac death, but the biological mechanisms remain unclear. We tested the hypothesis that, in patients with sudden death vulnerability, anger would be associated with arrhythmic vulnerability, indexed by cardiac repolarization instability. Methods: Patients with coronary artery disease (CAD) and an implantable cardioverter defibrillator (ICD; n = 41) and healthy controls (n = 26) gave an anger-inducing speech (anger recall), rated their current (state) anger, and completed measures of trait (chronic) levels of Anger and Hostility. Repolarization instability was measured using QT Variability Index (QTVI) at resting baseline and during anger recall using continuous ECG. Results: ICD patients had significantly higher QTVI at baseline and during anger recall compared with controls, indicating greater arrhythmic vulnerability overall. QTVI increased from baseline to anger recall to a similar extent in both groups. In ICD patients but not controls, during anger recall, self-rated anger was related to QTVI (r =.44, p =.007). Trait (chronic) Anger Expression (r =.26, p =.04), Anger Control (r = −.26, p =.04), and Hostility (r =.25, p =.05) were each associated with the change in QTVI from baseline to anger recall (ΔQTVI). Moderation analyses evaluated whether psychological trait associations with ΔQTVI were specific to the ICD group. Results indicated that Hostility scores predicted ΔQTVI from baseline to anger recall in ICD patients (β = 0.07, p =.01), but not in controls. Conclusions: Anger increases repolarization lability, but in patients with CAD and arrhythmic vulnerability, chronic and acute anger interact to trigger cardiac repolarization lability associated with susceptibility to malignant arrhythmias.

Original languageEnglish
Article numbere12848
JournalAnnals of Noninvasive Electrocardiology
Issue number4
StatePublished - Jul 2021
Externally publishedYes


  • QT variability index
  • anger
  • arrhythmia
  • repolarization instability


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