Table 2

Summary of evidence for a role of mental stress in arrhythmias and sudden death

Model	Evidence	References
Anecdotal reports	Anecdotal reports from modern to ancient times	28
National disasters	SCD increases at times of national disasters	30–32
Experimental models in animals	Vagal stimulation protects against stress-induced arrhythmia in dogs	36
	Stress magnifies the pro-arrhythmic effects of ischaemia	29
	Fronto-amygdala brain section prevents stress-induced VF	45
	Central acting β-blockers prevent stress-induced VF	46
Humans	Stress induces coronary or microvascular constriction and ischaemia	41–44
	Stress tasks and anger induce ECG T-wave alternans	47 48
	Anger potentiates ventricular arrhythmias	38
	β-Blockade protective for SCD	3
	Emotion precipitates VF in long QT patients	3
Socioeconomic influence	Chronic psychsocial factors inflence rates of arrhythmia and sudden death	37