Abstract Body (Do not enter title and authors here): Background:
Acute stress has been linked to increased arrhythmic activity, but little is known about how mental disorders modify this relationship in patients with coronary heart disease (CHD). Increased arrhythmia burden substantially elevates the risk of sudden cardiac death; thus, examining the role of mental disorders in mental stress-induced arrhythmia is essential for informing targeted prevention strategies in this high-risk population.
We tested the hypothesis that in individuals with recent myocardial infarction (MI) and in normal sinus rhythm, mental disorders are associated with an increased risk of ectopic atrial and ventricular arrhythmias during a standardized speech stressor challenge.

Methods:
We studied a cohort of 304 post-MI participants with structured clinical interviews to diagnose major depression and post-traumatic stress disorder (PTSD). We measured premature atrial (PAC) and ventricular contractions (PVC) from Holter data in 5-minute intervals before, during, and after a standardized laboratory-based 5-minute speech stressor. We examined the associations between mental disorders and changes in PAC/PVC counts after stress using multivariable logistic regression.

Results:
The mean age 52 (SD ±7) years, 56% were women, and 52% were black (Table 1). Among participants with MI, depression was associated with greater PAC increases during stress (OR=3.16, 95% CI: 1.22–7.58, p=0.012); this remained significant after adjustment (OR=4.04, 95% CI: 1.46–10.70, p=0.005). PTSD was associated with higher PAC counts during recovery versus rest (OR=4.73, 95% CI: 1.42–13.80, p=0.005), persisting after adjustment (OR=11.80, 95% CI: 2.93–47.50, p < 0.001). Depression associated with increased PVCs during recovery compared to rest (OR=2.27, 95% CI: 0.98–4.93, p=0.046). However, statistical significance was lost after adjusting for demographic and traditional risk factors.

Conclusions:
In young and middle-aged individuals with prior MI, PTSD and depression were associated with an increased burden of arrhythmia under mental stress. The associations were stronger for atrial arrhythmias than ventricular arrhythmias.