2026 ECNP Congress

PS03-3029

Assessment of electrocardiographic cardiac arrhythmia risk markers in drug-free patients with generalized anxiety disorder: preliminary findings

Kaan Çabuk — B.N. Yedievli Bal, Z.B. Sarı, S.N. Erkal, H. Gökçay · University of Health Sciences- Bagcilar Training and Research Hospital, Psychiatry, İstanbul, Türkiye

2026 ECNP Congress

Objective: Generalized Anxiety Disorder (GAD) is associated with increased cardiovascular risk [1], which is partly mediated by autonomic nervous system dysfunction. This condition is characterized by persistent sympathetic overactivity and reduced parasympathetic modulation, potentially impairing cardiac electrical stability and resulting in subtle but measurable changes in electrocardiographic (ECG) parameters. P wave dispersion (Pd) reflects heterogeneous atrial conduction and has been linked to an increased risk of atrial fibrillation [2], while ventricular repolarization heterogeneity can be evaluated using corrected QT interval (QTc) and QTc dispersion (QTcd). In addition, corrected JT interval (JTc), JTc dispersion (JTcd), T peak – T end interval (Tp-e), and the Tp-e/QTc ratio provide further information about ventricular electrical stability [3]. Although these parameters allow a comprehensive evaluation of cardiac electrophysiology, studies simultaneously assessing atrial and ventricular markers in GAD remain limited. This study aims to evaluate ECG-derived markers of atrial conduction and ventricular repolarization in drug-free patients with GAD and compare them with healthy controls. Methods: This preliminary analysis of an ongoing study utilized a case-control design. The patient group comprised literate adults aged 18–65 years with a DSM-5 [4] psychiatric diagnosis of GAD. Patients utilizing psychiatric medication in the preceding month, or suffering from comorbid psychiatric, neurological, or rhythm-affecting medical conditions, were excluded. Controls were healthy individuals matched for age, sex, and education. Assessments included a Sociodemographic Form and the Beck Anxiety Inventory. Twelve-lead electrocardiograms were recorded during the morning in a standardized environment following supine rest. Evaluated parameters included Pd, QTc, QTcd, JTc, JTcd, Tp-e, and the Tp-e/QTc ratio. Statistical evaluation employed independent t-tests (t), chi-square tests (χ²), and Pearson correlation analysis (r), with a significance level set at p<0.05. Statistical analyses were performed using IBM Statistical Package for the Social Sciences (SPSS) for Mac OS, Version 23.0. Results: A total of 53 participants (GAD = 23, controls = 30) were included. There were no significant differences between groups in age, body mass index (BMI), sex distribution, or smoking status (all p > 0.05). Electrocardiographic analysis demonstrated significantly higher Pd, QTcd, JTc, and JTcd in the GAD group compared to controls (all p ≤ 0.003). Heart rate, QTc, Tp-e interval, and Tp-e/QTc ratio did not differ significantly between groups (all p > 0.05). Correlation analysis in the GAD group revealed that QTc and JTc showed significant positive correlations with Beck Anxiety Inventory scores (r = 0.437, p < 0.05; r = 0.475, p < 0.05). In addition, BMI was positively correlated with Tp-e interval (r = 0.421, p < 0.05). Conclusion: According to the results of our study, drug-free patients with GAD show changes in ECG-derived markers indicating autonomic nervous system dysfunction and impaired ventricular repolarization. These alterations may suggest an increased susceptibility to cardiac arrhythmias. Therefore, such electrophysiological changes should be taken into consideration in the cardiovascular evaluation and risk assessment of GAD patients.

References

  1. Todaro, J.F., Shen, B.J., Raffa, S.D., Tilkemeier, P.L., Niaura, R., 2007. Prevalence of anxiety disorders in men and women with established coronary heart disease. Journal of Cardiopulmonary Rehabilitation and Prevention 27 (2), 86-91.
  2. Ünsal, C., Kaplan, O.K., Soner Saygın, M.Z., Uzunlar, B., Uyarel, H., Çalışkan, M., 2013. P wave and QT dispersion in patients with generalized anxiety disorder. Kosuyolu Kalp Derg. 16 (3), 214-219.
  3. Yilmaz Coşkun, F., Elboğa, G., Altunbaş, G., Vuruşkan, E., Kaya Uğur, B., Sucu, M., 2018. Evaluation of ventricular repolarization features with Tp-e, Tp-e/QTc, JTc and JTd during electroconvulsive therapy. Journal of Electrocardiology 51 (3), 390-394.
  4. American Psychiatric Association, 2013. Diagnostic and statistical manual of mental disorders, fifth ed. American Psychiatric Association Publishing, Washington.