Exaggerated Beat-to-Beat R Amplitude Variability in Patients with Panic Disorder after Intravenous IsoproterenolYeragani V.K.a-c · Pohl R.a · Bär K.-J.d · Chokka P.b · Tancer M.a
aDepartment of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Mich., USA; bDepartment of Psychiatry, University of Alberta, Edmonton, Alb., Canada; cDepartment of Cardiology, M.S. Ramaiah Memorial Hospital, Bangalore, India; dDepartment of Psychiatry, Friedrich Schiller University, Jena, Germany
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Article / Publication Details
Background: Anxiety symptoms are associated with a marked increase in sudden cardiac death, suggesting an abnormality in cardiac autonomic function. Our previous studies show a relationship between R amplitude variability and sympathetic function.Methods:We examined the effects of β-adrenergic stimulation on R and T amplitude variability in panic disorder patients by infusing the β-adrenergic agonist isoproterenol in 6 panic disorder patients and 11 normal subjects. The ECG signal was analyzed before the infusion and 5 min after the infusion was started. The outcome measures were the R and T detrended variance normalized for mean amplitudes (Rvm and Tvm) and the Rvi and Tvi, measures which are normalized for the inter-beat interval variability in addition. Results: Patients with panic disorder had significantly more variability in R and T amplitude than normal controls and the R amplitude variability was increased further by β-adrenergic stimulation with isoproterenol, which was more pronounced in the patients. Conclusions: The isoproterenol-associated increase in R amplitude variability occurred in controls in the absence of significant anxiety. However, the increase in R amplitude variability was greater in patients with panic disorder, suggesting a greater sensitivity to β-adrenergic effects of isoproterenol or to isoproterenol-induced anxiety.
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- Coryell W, Noyes RJ, House JD: Mortality among outpatients with anxiety disorders. Am J Psychiatry 1986;143:508–510.
- Haines AP, Imeson JD, Meade TW: Phobic anxiety and ischemic heart disease. BMJ 1987;295:297–299.
- Kawachi I, Colditz GA, Ascherio A, Rimm EB, Giovannucci E, Stampfer MJ, Willett WC: Prospective study of phobic anxiety and risk of coronary heart disease in men. Circulation 1994;89:1992–1997.
- Bigger JT Jr, Fleiss JL, Steinman RC, Rolnitzky LM, Kleiger RE, Rottman JN: Frequency domain measures of heart period variability and mortality after myocardial infarction. Circulation 1992;85:164–171.
- Molgaard H, Sorensen KE, Bjerregaard P: Attenuated 24-h heart rate variability in apparently healthy subjects, subsequently suffering sudden cardiac death. Clin Auton Res 1991;1:233–237.
- Berger RD, Casper EK, Baughman KL, Marban E, Calkins H, Tomaselli GF: Beat-to-beat QT interval variability. Novel evidence for repolarization lability in ischemic and nonischemic dilated cardiomyopathy. Circulation 1997;96:1557–1565.
- Atiga WL, Calkins H, Lawrence JH, Tomaselli GF, Smith JM, Berger RD: Beat-to-beat repolarization lability identifies patients at risk for sudden cardiac death. J Cardiovasc Electrophysiol 1998;9:899–908.
- Yeragani VK, Sobolewski E, Igel G, Johnson C, Jampala VC, Kay J, Hillman N, Yeragani S, Vempati S: Decreased heart period variability in patients with panic disorder: a study of Holter ECG records. Psychiatry Res 1998;78:89–99.
- Yeragani VK, Pohl R, Jampala VC, Balon R, Ramesh C, Srinivasan K: Increased QT variability in patients with panic disorder and depression. Psychiatry Res 2000;93:225–235.
- Yeragani VK, Nadella R, Hinze B, Yeragani S, Jampala VC: Nonlinear measures of heart period variability: decreased measures of symbolic dynamics in patients with panic disorder. Depress Anxiety 2000;12:67–77.
- Yeragani VK, Rao KA: Nonlinear measures of QT interval series: novel indices of cardiac repolarization lability. Psychiatry Res 2003;117:77–90.
- Yeragani VK, Berger R, Pohl R, Srinivasan K, Balon R, Ramesh C, Weinberg P, Berchou R: Effects of yohimbine on heart rate variability in panic disorder patients and normal controls: a study of power spectral analysis of heart rate. J Cardiovasc Pharmacol 1992;20:609–618.
- Yeragani VK, Tancer M, Uhde T: Heart rate and QT interval variability: abnormal alpha-2 adrenergic function in patients with panic disorder. Psychiatry Res 2003;121:185–196.
- Yeragani VK, Berger R, Songer DA, Yeragani S: Power spectrum of the QRS complex in patients with panic disorder and normal controls. Psychiatry Res 1997;66:167–174.
- Yeragani VK, Mallavarapu M, Radhakrishna Rao KA, Tancer M, Uhde T: Linear and nonlinear measures of blood pressure variability: increased chaos of blood pressure time series in patients with panic disorder. Depress Anxiety 2004;19:85–95.
- Yeragani VK, Radhakrishna Rao KA, Tancer M, Uhde T: Nonlinear measures of respiration: respiratory irregularity and increased chaos of respiration in patients with panic disorder. Neuropsychobiology 2002;46:111–120.
- Hagerman I, Nowak J, Svedenhag J, Nyquist O, Sylven C: Beat-to-beat QRS amplitude during dobutamine infusion in patients with coronary artery disease. Cardiology 1996;87:161–168.
- Hagerman I, Berglund M, Svedenhag J, Nowak J, Sylven C: Beat-to-beat QRS amplitude variability after acute myocardial infarction and coronary artery bypass grafting. Am J Cardiol 1996;77:927–931.
- Yeragani VK, Appaya S, Seema KP, Kumar R, Tancer M: QRS amplitude of ECG in normal humans: effects of orthostatic challenge on linear and nonlinear measures of beat-to-beat variability. Cardiovasc Eng 2005;5:135–140.
Yeragani VK, Desai N, Chokka P, Tancer M: Increased beat-to-beat QRS amplitude variability in patients with congestive cardiac failure. Int J Cardiol, in press.
- Contrada RJ, Dimsdale J, Levy L, Weiss T: Effects of isoproterenol on T-wave amplitude and heart rate: a dose-response study. Psychophysiology 1991;28:458–462.
- Contrada RJ, Krantz DS, Durel LA, Levy L, LaRiccia PJ, Anderson JR, Weiss T: Effects of beta-adrenergic activity on T-wave amplitude. Psychophysiology 1989;26:488–492.
Spitzer RL, Williams JBW, Gibbon M: Structured Clinical Interview for DSM III-R (SCID). New York, New York State Psychiatric Institute, 1987.
- Yeragani VK, Pohl R, Srinivasan K, Balon R, Ramesh C, Berchou R: Effects of isoproterenol on heart rate variability in patients with panic disorder. Psychiatry Res 1995;56:289–293.
- Rainey JM, Ettedgui E, Pohl R, Balon R, Weinberg P, Yelonek S, Berchou R: The beta-receptor: isoproterenol anxiety states. Psychopathology 1984;17(suppl 3):40–51.
- Pohl R, Yeragani VK, Balon R, Rainey JM, Lycaki H, Ortiz A, Berchou R, Weinberg P: Isoproterenol induced panic attacks. Biol Psychiatry 1988;24:891–902.
- Pohl R, Yeragani VK: QT interval variability in panic disorder patients after isoproterenol infusions. Int J Neuropsychopharmacol 2001;4:17–20.
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