[Psychopharmaceuticals and arrhythmias].
Psychoactive drugs have been associated with arrhythmia for 40 years. Torsades de pointes was originally seen in patients with pre-existing heart disease or with intoxication. Now, there is increasing awareness that drugs used for non-antiarrhythmic and non-cardiovascular indications can exert significant effects on repolarisation and may cause ventricular tachycardia. Most of the drugs that prolong the QT-interval incorporate blockade of the potassium channel Ikr in their spectrum. Among psychotrophic drugs the low-potency phenothiazines have most often been implicated, particularly thioridazine. For the high-potency phenothiazines and butyrophenones there are fewer reports on serious arrhythmia. More recently the atypical antipsychotics have been introduced. Although some of them increase the QT-interval considerably arrhythmic events seem to be a very rare problem with the atypical antipsychotics available. Drugs acting as class I antiarrhythmics such as tricyclic antidepressants are not recommended after myocardial infarction. Selective serotonin reuptake inhibitors seem to be safe. Patients with a prolonged QT-interval or patients that experienced Torsade de pointes are at a considerable higher risk upon exposition to a QT-prolonging drug. Drug interactions played a role in many fatalities with QT-prolonging drugs and are important.
Binggeli
C
C
HerzKreislaufZentrum, Kardiologie, DIM, Universitätsspital Zürich.
Candinas
R
R
Brunckhorst
C
C
D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects; D014150:Antipsychotic Agents / Q000009:adverse effects; D001145:Arrhythmias, Cardiac / Q000139:chemically induced* / Q000401:mortality / Q000503:physiopathology; D018492:Dopamine Antagonists / Q000009:adverse effects; D004347:Drug Interactions; D004562:Electrocardiography; D006801:Humans; D008133:Long QT Syndrome / Q000139:chemically induced / Q000150:complications / Q000503:physiopathology; D009203:Myocardial Infarction / Q000150:complications; D010640:Phenothiazines / Q000009:adverse effects; D011619:Psychotropic Drugs / Q000009:adverse effects*; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000139:chemically induced / Q000503:physiopathology; D013881:Thioridazine / Q000009:adverse effects; D016171:Torsades de Pointes / Q000139:chemically induced / Q000150:complications / Q000503:physiopathology
D000929:Antidepressive Agents, Tricyclic; D014150:Antipsychotic Agents; D018492:Dopamine Antagonists; D010640:Phenothiazines; D011619:Psychotropic Drugs; D013881:Thioridazine