| BackgroundIn the context of rapid social and economic development,people’s life pressure is increasing year by year,and the incidence of mental illness is also greatly increased,such as suicide,social conflict,divorce and other events occur frequently.The in-depth research and clinical treatment of psychological diseases have gradually matured and exerted great influence.At the same time,many cardiology clinicians found that many patients with heart disease will also suffer from psychological diseases,and the two are mutually reinforcing and gradually worsening relationship.In 2006,some researchers first put forward the concept of "Psycho-cardiology",and then set off a wave of research on psycho-cardiology diseases in China.The occurrence of"Psycho-cardiology" can be divided into three types:One is the independent existence of psychological heart disease,patients with no organic changes in the heart,such as cardiac dysfunction;The second is psychological heart disease and heart disease,such as coronary heart disease with depression;The other is that heart disease,as a stress attack,causes psychological changes in patients,such as a sudden heart attack,and depression or anxiety after clinical treatment and discharge.In conclusion,there is a strong relationship between psychological problems and heart disease,both in terms of symptoms and diagnosis.At present,the research on "Psycho-cardiology" mainly focuses on CHD related psychological diseases,atrial fibrillation related psychological diseases and other fields.However,there are few reports on the psychological problems and prognosis caused by bradyarrhythmia at home and abroad,and there is no specific conclusion on the incidence and related factors.In this study,the classic and authoritative Hamilton scale in the field of psychological evaluation at home and abroad was used to conduct a questionnaire survey on patients with tardy arrhythmia.The Hamilton scale is the most classic scale for anxiety and depression in the world,which has been circulated for more than 50 years.We compared and screened a large number of assessment scales,including Hamilton scale and self-rating anxiety scale(SAS),self-rating depression scale(SDS),SCL90,sf-36 and the latest dsm-5 scale.Deletion factor analysis of SAS and SDS;However,SCLC90 and SF36 factors were too numerous and took too long to evaluate.Dsm-5 is not inferior to Hamilton scale in terms of evaluation level in all aspects,but since there was no professional evaluation on it in China at that time,we chose Hamilton scale most.Pacemakers are therapeutic for bradyarrhythmia,as in cardiac internal medicine rare curative measure,if also have positive effect to mental illness,which would have greater clinical value.Objectives1.To understand the incidence of chronic arrhythmia complicated with anxiety or depression.2.To investigate the effect of implantation of permanent cardiac pacemaker on anxiety or depression caused by bradyarrhythmia.3.Analyze the related factors of anxiety or depression caused by chronic arrhythmia.Methods212 Patients with bradyarrhythmia were carefully chosen from the outpatient department/clinic.Finally a total of 198 patients were enrolled in the group,including 96 in the control group and 102 in the pacemaker treatment group.The pacemaker in the pacemaker group is Medtronic RED01.The pacemaker was installed and adjusted by the same team.The pacemaker works normally after the operation and the condition is stable.In the drug treatment group,Xinbao pills were taken orally for 600mg/time and 3 times per day.Interpretation of the patient’s condition,treatment regimen,and complications was performed by the same data collector.Each patients’ basic information,past medical history,blood biochemical indexes,24 hour Holter monitoring,echocardiography results were acquired and completed Hamilton Anxiety Scale and Hamilton Depression Scale.According to the comprehensive assessment of the disease and the patients’ treatment intention,patients were divided into the conservative control group and the pacemaker treatment group.The above examination and questionnaire were completed again after 3 months.T test was used to compare the data before and after when non-parametric test was used to compare the count data.Results1.Results of basic and clinical data.1.1 There was no significant difference in age,gender,smoking history,drinking history,hypertension,diabetes and other basic data between the two groups(all P was>0.05).1.2 There were no statistically significant differences between the two groups(P<0.05)in symptoms of nocturnal wakefulness and syncope,the slowest heart rate,the longest RR interval,LVEF,Tei,etc.The symptoms of nocturnal wakefulness and syncope,the slowest heart rate and the longest RR interval in the pacemaker group were significantly improved compared with the drug group(all P<0.001).LVEF(P=0.309)and Tei index(P=0.068)were not significantly different between the two groups.1.3 In the drug treatment group,the slowest heart rate(P=0.011)and the longest RR interval(P<0.001)were significantly improved at the second visit,while there was no improvement in nocturnal wakening,syncope symptoms,LVEF,and Tei index(all P were>0.05).1.4 In the pacemaker treatment group,the slowest heart rate(P<0.001),the longest RR interval(P<0.001),nocturnal wakening(P=0.002),and syncope symptoms(P<0.001)were significantly improved during the follow-up,and LVEF and Tei indexes were also not significantly different(P<>0.05).2.Psychological assessment results.2.1 Overall prevalence:Among all patients with chronic arrhythmia(198 patients),only 6.06%had no symptoms of anxiety and depression at all,while the number of patients with comorbidity of pure depression and anxiety and depression reached 45.96%,with the lowest prevalence of pure anxiety(only 2.02%).Among them,52.02%of the patients did not have anxiety symptoms,36.87%might have anxiety,and 11.11%of the patients had anxiety(only 2 of them had obvious anxiety).However,only 9.09%of the patients did not have depressive symptoms,75.25%of the patients had mild depressive symptoms,and 15.6%of the patients were complicated with moderate depression.2.2 Comparison of anxiety grades:At the first diagnosis,the pacing treatment group was in the perioperative period,and the number of patients with positive anxiety symptoms was more than the drug treatment group,with statistically significant difference(P=0.023).However,at the second visit,the number of patients with positive anxiety in the pacing treatment group decreased significantly,only 31.37%showed possible anxiety,and the remaining 68.63%showed no anxiety symptoms.From the comprehensive statistics,the proportion of patients who showed simple anxiety(positive anxiety was downgraded to possible anxiety)in the pacing group increased(14.71%).Although there was a decrease in pure depression or pure anxiety in the drug treatment group at the second visit,they were all converted into more severe anxiety and depression comorbidity,with a significant decrease in the comprehensive evaluation(P<0.001).2.3 Comparison of anxiety factors and total scores between the two groups:At the first diagnosis,there was no significant difference in anxiety factor and total score between the two groups(P =>0.05).At the second visit,anxiety factors and total scores in the pacemaker group were significantly improved compared with the drug treatment group(all P<0.001).2.4 Comparison of anxiety before and after treatment in pacemaker group:At the second visit,physical anxiety symptoms were not significantly improved in the pacemaker group(P=0.129),but mental anxiety symptoms were significantly improved(P=0.003),and overall anxiety was significantly improved(P=0.001).2.5 Comparison of anxiety before and after treatment in the drug group:The physical anxiety symptoms were significantly aggravated(P<0.001),while the mental anxiety was not significantly changed(P=0.685),and the overall anxiety was significantly aggravated(P=0.001).2.6 Comparison of depression grades:There was no statistical difference in depression between the two groups at the first diagnosis(P=0.761).At the time of follow-up,the proportion of mild to moderate depression in the pacemaker group decreased significantly,the proportion of no depressive symptoms increased from 8.82%to 56.86%,and the depressive symptoms were significantly improved(P<0.001).The proportion of mild to moderate depressive symptoms in the drug treatment group increased slightly.From the overall comprehensive data,the proportion of pure depression after pacing treatment decreased from 51.96%to 26.47%,and the proportion of anxiety and depression co-morbidity decreased from 39.22%to 16.67%.In the drug treatment group,1/3 of pure depression was converted into anxiety and depression comorbid,which was significantly aggravated with psychological symptoms compared with the pacemaker treatment group(P<0.001).2.7 Comparison of depression factors and total scores between the two groups:At the first diagnosis,there was no significant difference in depression factors and total scores between the two groups(P>0.05).In addition to cognitive impairment(P=0.669),other factors(anxiety/somatization,block,sleep disorder,despair,weight change)and total scores in the pacemaker treatment group were significantly lower than those in the drug treatment group(P<0.001).2.8 Comparison of depression before and after treatment in pacemaker group:The depression factors(anxiety/somatization,block,hopelessness,sleep disturbance,weight change)and the total depression score were significantly improved(P<0.001).Other factors:cognitive impairment(P=0.831)and day-night change(P=0.761)did not change significantly.The symptoms of depression in the pacemaker group were significantly improved.2.9 Comparison of depression before and after treatment in the drug group:During the follow-up,the weight changes and day-night changes in the depression factors were significantly aggravated(P<0.001),and the total score of depression was significantly increased(P=0.014).No significant changes were observed in other depression factors(P>0.05).3.Efficacy analysis3.1 At the second visit,23.53%of the patients with anxiety in the pacing group experienced relief of anxiety symptoms;Among the patients with depression,59.80%of the depressive symptoms were relieved.3.2 At the second visit,1.04%of the patients with anxiety in the drug group were relieved of anxiety symptoms;Among the patients with concurrent depression,9.38%had their depressive symptoms relieved.3.3 At the second visit,27.08%of the patients with anxiety in the drug group had aggravated anxiety symptoms;Among the patients complicated with depression,23.96%had worsening depressive symptoms.3.4 Compared with the drug group,pacemaker installation had a significant effect on symptoms of anxiety and depression(P<0.001).4.Spearman correlation analysis results.In patients with chronic arrhythmias complicated with anxiety or depression,anxiety was significantly positively correlated with women,age,nocturnal wakefulness,syncope symptoms,longest RR interval,smoking,drinking,hypertension,diabetes,etc.(all P<0.05).There was a significant positive correlation between depression and diabetes mellitus,female,age,symptoms of nocturnal wakefulness and syncope(all P<0.05).Conclusions1.Among patients with tardy arrhythmia,the incidence of pure anxiety is low,and the incidence of pure depression and "Anxiety and depression comorbidity" are both high.2.The installation of pacemaker can significantly improve the anxiety and depression symptoms associated with chronic arrhythmia.3.Chronic arrhythmia complicated with anxiety or depression is significantly correlated with female,age,symptoms,history of hypertension or diabetes. |
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