To the Editor.—
Brodsky et al1 should be congratulated for a fine presentation revealing the connection between psychological stress and life-threatening arrhythmia. They raise a crucial issue: some individuals with complex ventricular arrhythmia in the setting of emotional stress and high sympathetic tone are at risk for sudden cardiac death regardless of the presence of coronary artery disease or the status of their left ventricular function. βBlockers appear to be cardioprotective for patients in this subset. The reasons why some individuals respond to psychological stress with malignant arrhythmia are both unclear and provocative. There is a connection between emotional stress and cardiac vulnerability. Behavioral response to stress and subsequent neuroendocrine response to emotion will eventually occur in susceptible individuals, but sensitivity to emotion is variable. Some individuals prone to cardiovascular disorders probably have in their character an oversensitivity to emotional arousal, psychological conflict, or personal loss. Such arousal can
Sinatra ST. Ventricular Tachyarrhythmia and Psychological Stress. JAMA. 1987;258(6):783. doi:10.1001/jama.1987.03400060059026
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