QTc Interval and Risk of Cardiac Events in Adults With Anorexia Nervosa

Frederiksen, Tanja Charlotte; Christiansen, Morten Krogh; Østergaard, Pernille Charmoth; Thomsen, Per Hove; Graff, Claus; Clausen, Loa; Jensen, Henrik Kjærulf

doi:10.1161/circep.117.005995

Cited by 15 publications

(19 citation statements)

References 48 publications

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“…However, given that this study was not powered to assess sudden cardiac death, it is not surprising that no deaths were observed; based on previously reported data, 4 it would be expected that more than 5600 patients with AN would need to be monitored for 1 year to observe at least 1 episode of ventricular tachycardia. Given the severity of their disease, our study population would be expected to be at the high end of the risk spectrum for arrhythmic events.…”

Section: Discussionmentioning

confidence: 99%

“…It is defined as a body mass index (BMI) < 18.5 kg/m 2 , with severe AN defined as a BMI < 15 kg/m 2 . 3,4 A number of cardiac structural abnormalities, including pericardial effusion and myocardial atrophy, are prevalent in patients with AN. 2 Approximately 50% of deaths are thought to occur as a result of medical complications, including sudden cardiac death.…”

Section: Introductionmentioning

confidence: 99%

“…4,[13][14][15][16][17][18][19] Notably, in a small, retrospective study using centrally adjudicated digital electrocardiographic measurements in hospitalized patients with AN, marked QTc prolongation reflected the presence of medications known to block the delayed rectifier potassium ion current or significant hypokalemia. However, studies of cardiac repolarization abnormalities in patients with AN are largely retrospective and have produced conflicting results.…”

Section: Introductionmentioning

confidence: 99%

“…While AN is known to alter cardiovascular structure and function, and possibly cardiac repolarization, whether these abnormalities represent a mechanistic link to the high risk of sudden death in AN remains uncertain, primarily because definitive data on the occurrence of premorbid cardiac arrhythmias are sparse. 3,4 A number of cardiac structural abnormalities, including pericardial effusion and myocardial atrophy, are prevalent in patients with AN. 5 In addition, patients with AN have been shown to have myocardial fibrosis, demonstrated by late gadolinium enhancement on cardiac magnetic resonance imaging, 6 endomyocardial biopsy, 7 and autopsy reports, 8 implicating a primary substrate for ventricular tachyarrhythmias.…”

Section: Introductionmentioning

confidence: 99%

“…However, studies of cardiac repolarization abnormalities in patients with AN are largely retrospective and have produced conflicting results. 4,[13][14][15][16][17][18][19] Notably, in a small, retrospective study using centrally adjudicated digital electrocardiographic measurements in hospitalized patients with AN, marked QTc prolongation reflected the presence of medications known to block the delayed rectifier potassium ion current or significant hypokalemia. 20 To our knowledge, there are no published data on long-term cardiac rhythm monitoring in patients with AN.…”

Section: Introductionmentioning

confidence: 99%

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Long‐term cardiac arrhythmia and chronotropic evaluation in patients with severe anorexia nervosa (LACE‐AN): A pilot study

Farasat

Watters

Bendelow

et al. 2020

Cardiovasc electrophysiol

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Background: Anorexia nervosa (AN) is associated with autonomic dysfunction and carries a high risk of sudden death, putatively attributed to ventricular tachyarrhythmias. To date, long-term cardiac monitoring has not been performed to confirm this speculation. Methods and Results:We assessed the safety and acceptability of an insertable cardiac monitor (ICM) in patients with severe AN with markedly reduced body mass index (BMI), and investigated heart rate (HR) and rhythm before and after weight restoration. Autonomic function was assessed as HR response to a standardized activity protocol at baseline and four additional visits over 360 days. The Florida Patient Acceptance Survey (FPAS) was used to measure ICM acceptability.During a mean follow-up of 10 months, no ICM-related complications occurred and ICM was well-accepted by the 11 study participants (nine women, aged 19-59 years, baseline BMI = 12.7 ± 1.6 kg/m 2 ). Both resting and peak HR increased with weight restoration and were directly associated with BMI (both P < .001). No ventricular tachyarrhythmias occurred during the study period, but two participants (18%) experienced eight sinus pauses (3.0-7.0 seconds) and three runs of supraventricular tachycardia.Conclusions: Long-term cardiac rhythm monitoring with an ICM is feasible, safe, and acceptable in patients with severe AN. Autonomic dysfunction in AN results in not only profound resting bradycardia, but also some degree of chronotropic incompetence, both of which improve with weight restoration. Clinically significant bradyarrhythmias are more common than ventricular tachyarrhythmias in AN, and may represent a competing underlying mechanism for the high risk of sudden death in this population. K E Y W O R D Sadult, anorexia nervosa, autonomic dysfunction, long-term cardiac monitoring

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Long‐term cardiac arrhythmia and chronotropic evaluation in patients with severe anorexia nervosa (LACE‐AN): A pilot study

Farasat

Watters

Bendelow

et al. 2020

Cardiovasc electrophysiol

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Overall and cause‐specific mortality in anorexia nervosa; impact of psychiatric comorbidity and sex in a 40‐year follow‐up study

Søeby,

Gribsholt,

Clausen

et al. 2024

Intl J Eating Disorders

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ObjectiveThis study investigates the overall and cause‐specific mortality in males and females with anorexia nervosa (AN) from 1977 to 2018, focusing on the impact of psychiatric comorbidity on mortality risk, a less explored aspect despite a high prevalence in patients with AN.MethodWe conducted a nationwide population‐based cohort study in Denmark including all patients with AN (n = 14,774) with a median follow‐up time of 9.1 years and a 1:10 age‐ and sex‐matched general population comparison cohort. Using Cox proportional hazard model, we calculated adjusted hazard ratios (aHR) for death stratified by psychiatric comorbidity, sex, and age at AN onset and evaluated the causes of death using Fine and Gray sub‐distribution hazard ratios (SHR).ResultsIn patients with AN, the weighted average aHR for all‐cause mortality was 4.5 [95% CI 4.1–4.9] with up to 40 years follow‐up. Psychiatric comorbidity was present in 47% of patients with AN at index date, which was associated with a 1.9‐fold increase in 10‐year mortality compared with patients without comorbidity and a notably four‐fold increase, when diagnosed at age 6–25 years. The mortality risk was similar according to sex. 13.9% of all deaths in patients with AN were due to suicide (SHR 10.7 [8.1–14.2]). The risk of dying of natural causes was increased with a SHR of 3.8 [95% CI 3.4–4.2].DiscussionThe increased mortality risk in both males and females with AN and psychiatric comorbidity, particularly when diagnosed at young age, underscores the need for comprehensive treatment addressing both AN and coexisting psychiatric conditions.Public SignificanceThe mortality in patients with anorexia nervosa (AN) is high and we show in our study that the mortality is doubled in the presence of psychiatric comorbidity particularly the first 10 years after diagnosis seen in both sexes and with suicide as a major cause of death. These findings stress the importance of detection and treatment of psychiatric comorbidities alongside the eating disorder to prevent fatal outcome.

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Frequency of QTc Interval Prolongation in Children and Adults with Williams Syndrome

et al. 2022

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QTc Interval and Risk of Cardiac Events in Adults With Anorexia Nervosa

Abstract: Overall, there was no difference in mean QTc interval or risk of prolonged QTc between AN patients and healthy controls. However, AN patients had a notably increased all-cause mortality, as well as an increased risk of cardiac events, which was not related to the baseline QTc interval.

Cited by 15 publications

References 48 publications

Long‐term cardiac arrhythmia and chronotropic evaluation in patients with severe anorexia nervosa (LACE‐AN): A pilot study

Long‐term cardiac arrhythmia and chronotropic evaluation in patients with severe anorexia nervosa (LACE‐AN): A pilot study

Overall and cause‐specific mortality in anorexia nervosa; impact of psychiatric comorbidity and sex in a 40‐year follow‐up study

Frequency of QTc Interval Prolongation in Children and Adults with Williams Syndrome

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