Saratoga Springs Psychiatrist Bick Wanck, M.D., Publishes Paper About Personal Experience with AF in Prestigious Medical Journal
The Centers for Disease Control and Prevention has designated February “heart month” to raise awareness of cardiovascular health.
SARATOGA SPRINGS – Saratoga Springs-based psychiatrist Bick Wanck, M.D., has published a paper in the November 2022 issue of the prestigious “Journal of Atrial Fibrillation & Electrophysiology” titled “Psychological Stress Associated – Vagal Mediated Atrial Fibrillation: Personal Observation of a Possible Subtype.” In addition to his private practice, Wanck is an assistant professor of clinical psychiatry at Albany Medical College and a founding member of the American Academy of Addiction Psychiatry. He also authored the book “Mind Easing: The Three-layered Healing Plan for Anxiety and Depression.” He has been practicing psychiatry and living in Saratoga Springs for more than three decades.
What makes the paper extraordinary is that Wanck’s subject for the paper is his own personal experiences with stress and atrial fibrillation (AF). Atrial fibrillation is an abnormal heart rhythm characterized by rapid and irregular beating of the atrial chambers of the heart. It often begins as short periods of abnormal beating, which become longer or continuous over time. Symptoms may include heart palpitations (fluttering sensation), fainting, lightheadedness, shortness of breath, or chest pain. The biggest concern with atrial fibrillation is that it can cause blood to pool and form clots in the atrium. If left untreated, AF can cause a stroke in as many as one out of three sufferers. Wanck reports he used an anticoagulant during the study.
Wanck’s self-report describes, for the first time, a possible association with daytime psychological stress and AF hours later. In order to record an AF episode, Wanck used a simple hand-held EKG recording device available to anyone without a prescription. When linked to an app on a smartphone, it can detect AF. During a 22-month observation period, 121 episodes of AF were recorded; 105 of them (86.8%) occurred six to 12 hours after episodes of intense psychological stress. The unique characteristics of psychological stress associated with AF may warrant stress-reduction strategies along with standard medical treatment, he says, adding that “further investigation of the phenomenon would be useful.”
Aside from age, Wanck has no risk factors associated with AF and had normal findings in a thorough cardiac and physical workup. The absence of risk factors or other disease increases the likelihood that his AF was caused by stress. Possibly relevant, he says, is his personal history of trauma, including childhood abuse, torture, street fighting, and high-risk sports. “Decades of adrenaline surges may have increased my vulnerability to AF,” Wanck points out, adding that people who experienced early-life adversity may be more vulnerable to stress-associated illness later in life.
“I deemed self-perceived, present-day psychological stress intense when the degree of stress substantially exceeded my usual day-to-day stress,” Wanck says. “As a practicing psychiatrist and owner-director of a 24-clinician practice in two locations while writing a book and engaging in social media and speaking engagements, I had many opportunities for intense bouts of stress.”
In addition to medication, Wanck employed workload reduction and frequent use of brief mindfulness exercises. He calls his brief mindfulness exercise STOP-SIT-BREATHE and it goes like this: When you notice you are rushing, angry or scared, STOP what you are doing, SIT (or stand still), take a deep breath, then breathe naturally and for 30 seconds pay attention only to your breath. When your mind wanders, return to paying attention only to your breath. By doing this, you can interrupt your stress and restore a steady pace.
Wanck terminated the study after 22 months because his AF episodes started happening more frequently and lasting longer. With the help of a cardiologist, he began treatment with antiarrhythmic medication. Another form of treatment is a minor surgical procedure, called ablation, which Wanck says he’ll consider if the medication fails. As a result of medication plus stress reduction, two years have elapsed with no AF episodes, and he has had fewer episodes of psychological stress.
Wanck suggests “Day-to-day and moment-to-moment stress-reduction exercises can be especially effective when combined with lifestyle stress reduction. Reducing workload, addressing problematic relationships, and decompressing schedules may be difficult, but necessary, for individuals who chronically push themselves too hard. As the capacity to manage stress diminishes with age and the vulnerability of tissues to stress increases with age, stress reduction may be especially important for aging individuals, including those who are retired.”
Any individual experiencing atrial fibrillation (AF) should report it to his or her primary care provider and/or cardiologist and/or therapist, or go to an emergency department or urgent care immediately, as medical management or mental-health and/or mindfulness support may be appropriate.
