Psychotropic drugs and ventricular repolarisation: The effects on QT interval, T-peak to T-end interval and QT dispersion

Acciavatti, T.; Martinotti, Giovanni; Corbo, Mariangela; Cinosi, Eduardo; Lupi, M.; Ricci, Fabrizio; Scala, Rosa Di; D’Ugo, Emilia; Viola, Francesco; Caterina, Raffaele De; Giannantonio, Massimo Di

doi:10.1177/0269881116684337

Cited by 28 publications

(28 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A prolonged QTc interval was observed in our study in 7.6% of the patients, but only one case had a QTc interval ⩾500 ms, which is the threshold considered to be a strong predictor of drug’s risk to cause torsades de pointes in both sexes. 30 This prevalence is consistent with the observed rates of QTc prolongation reported in the main studies performed in hospitalized psychiatric patients, with the majority of the values ranging between 2% and 17%, 10,23,25–27,31–43 but up to 38% in some studies. 33,44 In somatic inpatients, the prevalence of QTc prolongation seems to be higher than in psychiatric inpatients, with rates varying between 22% and 35%.…”

Section: Discussionsupporting

confidence: 90%

Prevalence of ECG abnormalities and risk factors for QTc interval prolongation in hospitalized psychiatric patients

Ansermot

Bochatay

Schlapfer

et al. 2019

Therapeutic Advances in Psychopharmacology

View full text Add to dashboard Cite

Background: Psychiatric patients are at risk of cardiovascular diseases, and many psychotropic drugs can prolong QTc interval. Requirements for electrocardiogram (ECG) monitoring have been set up in our psychiatric university hospital. The objective of this study was to determine the proportion of adult patients who had an ECG during their hospitalization, the prevalence of ECG abnormalities, the evolution of the QTc after admission, and the risk factors for QTc prolongation. Methods: Retrospective analysis of ECGs and clinical data of all patients with a complete hospitalization in 2015. Assessment of the influence of covariates on QTc using linear mixed-effects models. Results: At least one ECG ( n = 600) was performed during 37.6% of the stays ( n = 1198) and in 45.5% of the patients ( n = 871). Among the patients with an ECG, 17.9% had significant ECG abnormalities, including 7.6% with a prolonged QTc. QTc measured at admission and during hospitalization did not change significantly ( n = 46, 419.4 ± 29.7 ms, 417.2 ± 27.6 ms, p = 0.71). In the multivariate model (292 patients, 357 ECGs), the covariates significantly associated with the QTc were gender (+15.9 ms if female, p < 0.0001), age (+0.4 ms/year, p = 0.0001), triglyceride levels (+5.7 ms/mmol/l, p = 0.005), and drugs with known risk of torsades de pointes (+6.2 ms if ⩾1 drug, p = 0.028). Conclusions: The prevalence of hospitalized psychiatric patients with an abnormal ECG indicates that ECGs should be performed systematically in this population. Prescription of psychotropic drugs should be done cautiously, particularly in patients with QTc prolongation risk factors.

show abstract

Section: Discussionsupporting

confidence: 90%

Prevalence of ECG abnormalities and risk factors for QTc interval prolongation in hospitalized psychiatric patients

Ansermot

Bochatay

Schlapfer

et al. 2019

Therapeutic Advances in Psychopharmacology

View full text Add to dashboard Cite

show abstract

“…QTD and the QTD ratio (divided by cycle length and expressed as a percentage) in patients with acute myocardial infarction exhibiting ventricular fibrillation were significantly higher relative to those observed in patients with unstable angina [13]. It has been reported that methadone led to modest increases in QTD and TpTe [5,8]. The TpTe was associated with increased mortality (a cut-off value of 100 ms) [14].…”

Section: Effects Of Methadone On Cardiac Repolarizationmentioning

confidence: 92%

“…Similar to TpTe, the TpTe/QT ratio is considered as a crucial marker of TDR and a noninvasive arrhythmogenic index of sudden cardiac death [6]. A previous study reported that TpTe was prolonged by methadone [8]. However, it is important to note that most previous studies involved patients with opioid dependency but not cancer.…”

Section: Introductionmentioning

confidence: 99%

Effect of Methadone on Cardiac Repolarization in Japanese Cancer Patients: A Longitudinal Study

Yamanaka¹,

Chino²,

Takasusuki³

et al. 2019

Cardiol Ther

View full text Add to dashboard Cite

Introduction: Methadone is known to prolong the QT interval, which could induce lethal arrhythmias such as torsades de pointes. To determine the risk of ventricular arrhythmias in cancer patients using methadone, we measured QT dispersion (QTD) and Tpeak-Tend (TpTe) before and after methadone administration and evaluated the correlations between methadone dosage and cardiac repolarization. Methods: We conducted a retrospective observational study with 19 patients undergoing follow-up for cancer pain with methadone. Electrocardiogram (ECG) recordings were obtained from the patients at methadone initiation and 1 week, 1 month, and 2 months later. The QT, corrected QT (QTc), QTD, QTc dispersion (QTcD), TpTe, TpTe/QT, and TpTe/QTc were measured manually via ECG records and analyzed using a repeated measures one-way ANOVA. The correlations between these ECG parameters and each methadone dosage were determined using Spearman's rank correlation coefficient. Results: The QTD, QTcD, TpTe/QT, and TpTe/ QTc remained unchanged, while TpTe was prolonged significantly at 2 months (initiation: 82 ± 17 ms; 2 months: 106 ± 20 ms, p = 0.018). In addition, there was a positive correlation between TpTe and methadone dosage (rs = 0.4, p = 0.041). Conclusions: The findings suggested that small or modest doses of methadone could exert dosedependent effects on cardiac repolarization in cancer patients.

show abstract

“…34 IGF-1 increases both the activity and the expression of hEAG channels through an AKT-dependent pathway, 195 and restoration of depressed hERG channel function is proposed as a mechanism for insulin treatment of abnormal QT prolongation and associated arrhythmias in diabetic rabbits. 196 Although some HDAC inhibitors have also been reported to inhibit hERG channel through complex transcriptional changes of genes required for ion channel trafficking, 197 there is no evidence that VPA (discussed above) prolongs the QT interval [198][199][200] and therefore, by inference, does not inhibit the hERG channel.…”

Section: Potential Use In Oncologymentioning

confidence: 99%

Repurposing old drugs in oncology: Opportunities with clinical and regulatory challenges ahead

Shah

Stonier

2018

J Clin Pharm Ther

View full text Add to dashboard Cite

show abstract

Psychotropic drugs and ventricular repolarisation: The effects on QT interval, T-peak to T-end interval and QT dispersion

Cited by 28 publications

References 36 publications

Prevalence of ECG abnormalities and risk factors for QTc interval prolongation in hospitalized psychiatric patients

Prevalence of ECG abnormalities and risk factors for QTc interval prolongation in hospitalized psychiatric patients

Effect of Methadone on Cardiac Repolarization in Japanese Cancer Patients: A Longitudinal Study

Repurposing old drugs in oncology: Opportunities with clinical and regulatory challenges ahead

Contact Info

Product

Resources

About