Catheterization and Cardiovascular Diagnosis 9:533-535 (1983)

Letter to the Editor

Changes in Cardiac Rate and Rhythm in Physicians Performing Cardiac Catheterization

TO THE EDITOR

A physician performing cardiac catheteriza- tion is subjected to both physical and mental stress. A relationship between stress and ar- rhythmias has been suggested by several stud- ies [1,2]. This study was done to document any changes in rhythm and rate in healthy physicians while performing cardiac catheterization.

Ten physicians were Holter monitored while performing routine cardiac catheterization. Ages ranged from 29-44 years; there were eight males and two females. All subjects were healthy and asymptomatic with no history of any medical illness. All had normal physical exams and none were taking any medications. The catheterization procedures lasted from 40 minutes to 3 hours and 20 minutes. All cases were routine and there were no unusual com- plications during these cases.

The same subjects were then Holter moni- tored for 1 hour during their routine in hospital workday activities, excluding cardiac cathet- erization or other invasive procedure. No sub- ject reported any symptom either during the catheterization or workday period.

The results are shown in Table I. No ectopic beats or abnormal rhythms were observed in either the catheterization or workday period. Peak heart rates ranged from 75-150 per min- Ute and average heart rates ranged from 68- 128 per minute during catheterization. During the workday period, peak rates ranged from 75-168 beats per minute and average rates ranged from 71-123 per minute. The average and peak heart rates during catheterization ex- ceeded (p < 0.5) average and peak workday rates by an average of 5.6% and4.9%, respec-

tively. Peak rates during catheterization and workday activity were significantly below 85 % of the predicted maximum heart rate of each subject in all except one subject. There ap- peared to be no relationship between the rates observed and age or experience with the procedure.

Some studies have suggested that there may be a relationship between stress and arrhyth- mias, both in normals and in patients with heart disease. During public speaking, 6 of 20 normal subjects had more than 6 PVCs per minute and two had multifocal PVCs [2], 30% of normal subjects aged 25-34 years had PVCs during treadmill exercise in one study, 6% also had supraventricular prematures [3]. In a study of patients with a history of arrhythmia, an increase in the frequency of PVCs was seen during psychological stress [I] . While driving, patients with abnormal hearts were noted to have ectopic beats [4]. It is speculated that increased levels of circulating catecholamines during stress may play a role in provoking these arrhythmias.

In our study, surprisingly, no ectopic beats of any kind were seen either during catheteri- zation or during the workday period. This may be due to the small number of subjects studied, or the fact that peak heart rates were generally well below 85% of predicted maximum of each subject, reflecting a lower level of stress and possibly circulating catecholamines than in the studies mentioned above.

This study did show, however, that average and peak heart rates during catheterization were significantly higher than during the workday period. This suggests that an uncomplicated

0 1983 Alan R. Liss, Inc.

UI

W

P

TAB

LE 1.

Res

ults

for

Phy

sici

ans

Hol

ter

Mon

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d W

hile

Per

form

ing

Car

diac

Cat

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tion

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a

Pred

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d W

ork

avg

Peak

wor

k n

$ w

ork

avgd

pe

ak w

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I s

Cat

h av

g -

Peak

cat

h -

85%

' C

atha

W

orkb

Age

(se

x)

Peak

A

vg

Peak

A

vg

max

Ec

topi

cs

(X

100

) (X

100

)

n

WM

) YO

76

75

68

15

1 N

one

11.8

%

20.0

%

39(W

11

1 YO

98

88

15

6 N

one

2.3%

13

.3%

I

36(F

) 13

0 11

1 12

4 98

15

9 N

one

13.2

%

4.8%

35

(F)

112

90

105

80

160

Non

e 12

.5%

6.

6%

34

M

81

71

80

74

161

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1%

1.2%

3

4M

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0 12

8 16

8 12

3 16

1 N

one

4.1%

10

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3

2(w

95

88

84

76

16

3 N

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15.2

%

13.2

%

31(M

) 86

76

85

73

16

4 N

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4.1%

1.

2%

3 1 (M

I 10

5 96

10

0 94

16

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one

2.1%

5.

0%

29(M

) 75

68

80

71

16

6 N

one

4.2%

6.

2%

Ran

ges

29-4

4 15

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12

8-68

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8-75

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3-71

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n (f

SD

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2.8

103.

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3 80

.5 k 1

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.9

28

89.4

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8 16

0 k 4

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5.6%

4.

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aThe

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and

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for e

ach

subj

ect.

Changes in Cardiac Rate and Rhythm 535

cardiac catheterization is physiologically more stressful for a physician than daily workday activities. We would expect that during a dif- ficult catheterization procedure, heart rates would be greater than those seen in this study.

Thus, for a healthy physician, cardiac cath- eterization is associated with higher peak and average heart rates than those seen during usual workday activity and there does not seem to be any tendency toward cardiac arrhythmias. Al- though not the subject of this study, we would anticipate that physicians with cardiovascular diseases might experience similar increases in heart rate when performing cardiac catheterization.

ACKNOWLEDGMENTS

We wish to acknowledge the technical assist- ance of Catherine Henihan, Sherrill Laskin, and Roberta Conroy.

REFERENCES

I , Lown B, DeSilva R, Lenson R: Roles of psycho- logical stress and autonomic nervous system changes in provocation of ventricular premature complexes. Am J Cardiol41:979-985, 1978.

2. Taggan P, Carruthers M, Somerville W: Elec- trocardiogram, plasma catecholamines and lip- ids, and their modification by oxprenolol when speaking before an audience. Lancet 21341-346, 1973.

3. McHenry P, Fisch C, Jordan J, Corya B: Car- diac arrhythmias observed during maximal treadmill exercise testing in clinically normal men. Am J Cardiol29:331-336, 1972.

4. Taggert P, Gibbons D, Somerville W: Some effects of motor-car driving on the normal and abnormal heart. Br Med J 4:130-134, 1969.

Robert Peters, MD Kul D. Chadda, MD New Hyde Park, NY