Psychological and perceptual factors associated with arrhythmias and benign palpitations

Objective: Little is known about how patients who seek medical help for ben ign palpitations can be distinguished from those with clinically significan t arrhythmias. This study tested whether patients with arrhythmia can be di stinguished from those who are aware of sinus rhythm or extrasystoles on th e basis of sex, prevalence of anxiety disorders, and heartbeat perception. Methods: A consecutive sample of patients referred to a cardiology clinic p articipated in the study. Patients were diagnosed as having either arrhythm ia (N = 62), extrasystoles (N = 75), or awareness of sinus rhythm (N = 47). They were assessed with use of the anxiety disorders and hypochondriasis m odules of the Structured Clinical Interview for DSM-IV. Both patients and c ontrol subjects (N = 35) answered questionnaires measuring anxiety, fear of bodily sensations, and depression and underwent a heartbeat perception tes t. The present report focuses on patients who had palpitations but no comor bid cardiovascular disease. Results: Patients with awareness of sinus rhyth m could be distinguished from those with arrhythmia by several variables: f emale sex, higher prevalence of panic disorder, poor performance on the hea rtbeat perception test, report of palpitations when doing the test, higher heart rates, lower levels of physical activity, and las trends) a greater p revalence of panic attacks, fear of bodily sensations, and depression. In c ontrast, patients with arrhythmias rarely reported palpitations when doing the test but were more likely to perceive their heartbeats accurately than patients with sinus rhythm and control subjects. Performance on the heartbe at perception test was intermediate in patients with extrasystoles; these p atients also had an intermediate prevalence of panic disorder and intermedi ate depression scores. Conclusions: Measures of panic disorder and a simple heartbeat perception test could complement medical assessment in the diagn osis of patients who seek medical help for palpitations. The results also h ave implications for the treatment of patients with benign palpitations.