Dichotomous approach to the treatmentof arrhythmias: it is impossible to healthe body without healing the soul

Authors: Pronicheva I.V., Mustapaeva Z.V.

Company: Bakoulev National Scientific and Practical Center for Cardiovascular Surgery of Ministry of Health of the Russian Federation; Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

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DOI: https://doi.org/10.15275/kreatkard.2017.01.06

For citation: Pronicheva I.V., Mustapaeva Z.V. Dichotomous approach to the treatment of arrhythmias: it is impossible to heal the body without healing the soul. Kreativnaya kardiologiya (Creative Cardiology, Russian journal). 2017; 11 (1): 56–70 (in Russ.). DOI: 10.15275/kreatkard.2017.01.06

Received / Accepted:  February 10, 2017 / February 27, 2017

Keywords: cardiac arrhythmias psychopathological disorders psychosomatic interrelations psychosocial adaptation cardiovascular diseases

Полнотекстовая версия:  



A review of studies for psychosomatic relations in cardiac arrhythmias are presented. There are considered psychopathological disorders that make symptoms of arrhythmia worse. Affective and psychosocial risk factors for cardiac diseases are defined. The patients with cardiac arrhythmias have frequently anxiety and hypochondriacal disorders. In addition, end-stage somatopathy is marked by depressive syndromes caused by the severe course of cardiovascular diseases resulting in heart failure. Despite visible progress in research of psychological problems associated with cardiac arrhythmias, a series of issues require in-depth investigation that related to therapy, rehabilitation and prevention activities for this group of patients.


  1. Chugh S., Reinier K., Teodorescu C. et al. Epidemiology of sudden cardiac death: clinical and research implications. Progr. Cardiovasc. Dis. 2008; 51 (3): 213–28.

  2. Mehra R. Global public health problem of sudden cardiac death. J. Electrocardiol. 2007; 40 (6): 118–22.

  3. Bockeria L.A., Stupakov I.N., Gudkova R.G.,Vatolin V.М. Surgical treatment of diseases of thecirculatory system in the Russian Federation(2010–2014 years)Vestnik Roszdravnadzora.2016;16: 63–9 (in Russ.).

  4. Komissarov S.I., Kuznetsov A.S., Chekalova E.G.Psychosomatic correlations in patients operatedon for atrial fibrillation. Vestnik neotlozhnoy i vosstanovitel'noy meditsiny.2003; 4 (16): 13–6(in Russ.).

  5. Linden M., Muschalla B. Standardized diagnostic interviews, criteria, and algorithms for mental disorders: garbage in, garbage out. Eur. Arch. Psychiatry Clin. Neurosci. 2012; 262 (6): 535–44.

  6. Whooley M.A., de Jonge P., Vittinghoff E. Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease. JAMA. 2008; 300: 2379–88.

  7. Lespérance F., Frasure-Smith N., Talajic M. et al. Five-year risk of cardiac mortality in relation to initial severity and one-year changes in depression symptoms after myocardial infarction. Circulation. 2002; 105: 1049–53.

  8. Dovzhenko Т.V. Depressive spectrum disorderswith cardiac syndrome in patients with cardiovas-cular diseases (clinic, diagnosis, therapy): Med. Sci.Diss. Author’s abstract. Мoscow; 2008 (in Russ.).

  9. Mangelli L., Bravi A., Favaet G.A. et al. Assessing somatization with various diagnostic criteria. Psychosomatics. 2009; 50 (1): 38–41.

  10. Von Kanel R. Psychosocial stress and cardiovascular risk: current opinion. Swiss. Med. Wkly. 2012; 142. http://doi.org/10.4414/smw.2012.13502.

  11. Porcelli P., Rafanelli C. Criteria for psychosomatic research (DCPR) in the medical setting. Curr. Psychiatry Rep. 2010; 12 (3): 246–54.

  12. Dunbar F. Character and symptom formation – some preliminary notes with special reference to patients with hypertensive, rheumatic and coronary disease. Int. J. Psycho-Anal. 1938; 8: 8–18.

  13. Friedman M., Rosenman R.H. Association of specific overt behavior pattern with blood and cardiovascular findings; blood cholesterol level, blood clotting time, incidence of arcus senilis, and clinical coronary artery disease. J. Am. Med. Assoc. 1959; 169 (12): 1286–96.

  14. Herrmann-Lingen C. Interdisciplinary training course рsychocardiology in primary care. Psychother. Psychosom. Med. Psychol. 2011; 61 (11): 489–90.

  15. Lampert R., Joska T., Burg M.M. et al. Emotional and physical precipitants of ventricular arrhythmia. Circulation. 2002; 106 (14): 1800–5.

  16. Baune B.T., Adrian I., Jacobi F. Medical disorders affect health outcome and general functioning depending on comorbid major depression in the general population. J. Psychosom. Res. 2007; 62 (2): 109–18.

  17. Fedorova V.I. The role of psycho-vegetative disor-ders in the development and course of arterialhypertension and cardiac rhythm disturbances, thepossibility of their correction: Dr. Med. Sci. Diss.Author’s abstract. Мoscow; 2009 (in Russ.).

  18. Sobczak M., Kasprzak J.D., Drygas W. Psychocardiology- introduction to a new scientific discipline. Kardiol. Pol. 2011; 69 (8): 838–43.

  19. Karas’kova E.A. Anxiety disorders in the genesis ofheart rhythm disturbances and the organization ofpsychotherapy in arrhythmological centers: Med. Sci.Diss. Author’s abstract. Мoscow; 2009 (in Russ.).

  20. Mattiloi A.V., Bonatti S., Zennaro M., Melotti R., Mattioli G. Effect of coffee consumption, lifestyle and acute life stress in the development of acute lone atrial fibrillation. J. Cardiovasc. Med. 2008; 9 (8): 794–8.

  21. Yurovskaya I.I. The role of anxiety and depressivedisorders in the genesis of paroxysms of atrial fib-rillation, taking into account surgical treatment:Med. Sci. Diss. Author’s abstract. Мoscow; 2013(in Russ.).

  22. Eaker E.D., Sullivan L.M., Kelly-Hayes M. et al.Anger and hostility predict the development of atrial fibrillation in men in the Framingham Offspring Study. Circulation. 2004; 109 (10): 1267–71.

  23. Eaker E.D., Sullivan L.M., Kelly-Hayes M. et al. Tension and anxiety and the prediction of the 10-year incidence of coronary heart disease, atrial fibrillation, and total mortality: the Framingham Offspring Study. Psychosom. Med. 2005; 67 (5): 692–6.

  24. Smulevich A.B., Volel’ B.A., Medvedev V.E. et al.Personality development in somatic diseases (to theproblem of acquired hypochondria). Psikhicheskierasstroystva v obshchey meditsine. 2008; 2: 3–11 (inRuss.).

  25. Grande G., Jordan J., Kummel М. et al. Evaluation of the German Type D Scale (DS14) and prevalence of the Type D personality pattern in cardiological and psychosomatic patients and healthy subjects. Psychother. Psychosom. Med. Psychol. 2004; 54 (11): 413–22.

  26. Lange H.W., Herrmann-Lingen C. Depressive symptoms predict recurrence of atrial fibrillation after cardioversion. J. Psychosom. Res. 2007; 63: 509–13.

  27. Nedostup A.V., Solov’eva A.D., Khaspekova N.B.The effect of clonazepam and antiarrhythmic drugson heart rate variability in patients with paroxysmalatrial fibrillation. Kardiologiya. 2005; 1: 35–40 (inRuss.).

  28. Minakov E.V., Kovalev S.A., Belov V.N., Belova E.A.Quality of life of patients with atrial fibrillation: theinfluence of drug therapy and catheter methods oftreatment. Zhurnal teoreticheskoy i prakticheskoymeditsiny. 2005; 1: 34–8 (in Russ.).

  29. Aleksander F. Psychjsjmatic medicine it's princi-ples and applicftions. Alexander Franz. Psychoso-matic medicine. The principles and practical appli-cation. Translation from English. Moscow:EKSMO-Press; 2002 (in Russ.).

  30. Brackett C.D., Powell L.H. Psychosocial and physiological predictors of sudden cardiac death after healing of acute myocardial infarction. Am. J. Cardiol. 1988; 61: 979–83.

  31. Soldatova O.G. Psychosomatic correlations in themechanisms of adaptation reactions in persons ofdifferent ages: Dr. Med. Sci. Diss. Author’sabstract. Tomsk; 2008 (in Russ.).

  32. San’kova T.A., Solov’eva A.D., Nedostup A.V.Comparative analysis of the symptomatology ofparoxysm of atrial fibrillation and panic attacks.Kardiologiya. 2004; 6: 26–30(in Russ.)

  33. Nicholson A., Kuper H., Hemingway H. Depression as an etiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146, 538 participants in 4 observational studies. Eur. Heart J. 2006; 27: 2763–74.

  34. Frasure-Smith N., Lespérance F., Talajic M. Depression and 18-month prognosis after myocardial infarction. Circulation. 1995; 91: 999–1005.

  35. Либис Р.А. Качество жизни больных с сердечно-сосудистыми заболеваниями: Автореф. дис. … д-ра мед. наук. Оренбург; 1998.

  36. American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders. 4th ed.,Text Revision (DSM-IV-TR). Washington: APA; 2000.

  37. Bennett P., Conway M., Clatworthy J., Brooke S., Owen R. Predicting post-traumatic symptoms in cardiac patients. Heart Lung. 2001; 30: 458–65.

  38. Krylov V.I., Egorov D.F. Psychological rehabi-litation of patients with implanted cardiostimula-tors. Klinicheskaya meditsina. 1989; 4: 74–7(in Russ.).

  39. Medvedev V.E., Zverev K.V., Epifanov A.V. Psy-chosomatic correlations in atrial fibrillation.Nevrologiya, neyropsikhiatriya, psikhosomatika.2011; 3 (4): 45–9 (in Russ.).

  40. Mattioli A.V., Bonatti S., Zennaro M. et al. The relationship between personality, socio-economic factors, acute life stress and the development, spontaneous conversion and recurrences of acute lone atrial fibrillation. Europace. 2005; 7: 211–20.

  41. January C.T., Wann L.S., Alpert J.S., Calkins H., Cleveland J.C., Jr., Cigarroa J.E. et al. 2014 AHA/ ACC/HRS Guideline for the management of patients with atrial fibrillation. J. Am. Coll. Cardiol. 2014. http://doi.org/10.1016/j.jacc.2014.03.022.23.

  42. Zoni-Berisso M., Lercari F., Carazza T., Domenicucci S. Epidemiology of atrial fibrillation: European perspective. Clin. Epidemiol. 2014 (6): 213–20.

  43. GBD 2013 Mortality and Causes of Death, Collaborators (17 December 2014). Global, regional, and national age-sex specific all-cause and causespecific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014; 385 (9963): 117–71.

  44. Kirchhof P., Benussi S., Kotecha D., Ahlsson A., Atar D., Casadei B. et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur. Heart J. 2016; 37 (38): 2893–962.

  45. Fedorets V.N. Ischemic heart disease in elderlypatients with behavioral type A: Dr. Med. Sci. Diss.Author’s abstract. St. Petersburg; 2011 (in Russ.).

  46. Bunova S.S. Hypertensive disease: violations ofpsychoneurohumoral interrelations and ways oftheir correction: Dr. Med. Sci. Diss. Author’sabstract. Omsk; 2009 (in Russ.).

  47. Golukhova E.Z. Clinico-morpho-functional fea-tures of ventricular arrhythmias; Indications andresults of surgical treatment: Dr. Med. Sci. Diss.Author’s abstract. Мoscow; 1995 (in Russ.).

  48. Bogun F., Crawford T., Reich S., Koelling T.M., Armstrong W., Good E. et al. Radiofrequency ablation of frequent, idiopathic premature ventricular complexes: comparison with a control group without intervention. Heart Rhythm. 2007; 4: 863–7.

  49. Kramynina O.A. Effect of therapy with antiar-rhythmic drugs (propafenone, amiodarone andmetoprolol) on the quality of life of patients withextrasystole: Med. Sci. Diss. Author’s abstract.Мoscow; 2009 (in Russ.).

  50. Gavril’eva S.A. Quality of life in patients with ven-tricular extrasystoles of high grades and its dynam-ics against the background of beta-blockers andamiodarone therapy: Med. Sci. Diss. Author’sabstract. Мoscow; 2004 (in Russ.).

  51. Glazunova E.V. Quality of life, anxious and depres-sive disorders in patients with extrasystolic arrhyth-mia and the possibility of their drug correction:Med. Sci. Diss. Author’s abstract. Orenburg; 2007(in Russ.).

  52. Huang C.X., Liang J.J., Yang B., Jiang H., Tang Q.Z. et al. Quality of life and cost for patients with premature ventricular contractions by radiofrequency catheter ablation. Pacing Clin. Electrophysiol. 2006; 29 (4): 343–50.

  53. Lebedeva U.V., Lebedev D.S. Psychologicalaspects and quality of life of patients in the surgicaltreatment of arrhythmias. Vestnik aritmologii. 2005;38: 23–8 (in Russ.).

  54. Lebedeva U.V. Dynamics of psychoemotional sta-tus and quality of life of patients with life-threaten-ing heart rhythm disorders: Dr. Med. Sci. Diss.Author’s abstract. St. Petersburg; 2006 (in Russ.).

About Authors

  • Pronicheva Irina Vladimirovna, MD, PhD, Cardiologist;
  • Mustapaeva Zaira Vakhaevna, Cardiologist

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery