The role of the selective serotonin re-uptake inhibitor sertraline in nondepressive patients with chronic ischemic heart failure: a preliminary study.
BACKGROUND
Selective serotonin re-uptake inhibitors (SSRIs) have been associated with better psychiatric status, functional capacity, and fewer arrhythmias in depressive patients with heart failure (HF). In this study, we tested the impact of sertraline (an SSRI) on patients with HF, but not clinical depression.


METHODS
We studied 62 clinically stable, nondepressive patients with ischemic HF (New York Heart Association class: I-II), and implantable cardioverter-defibrillator (ICD). Following psychiatric evaluation and quality of life (QoL) assessment, 24-hour electrocardiogram recordings including heart rate variability (HRV) and ICD interrogation were performed every 4 months for 1 year. Ventricular effective refractory period (ERP) at 600-, 500-, and 400-ms cycle length and the inducibility of ventricular tachycardia (VT) were assessed via the ICD. After that, sertraline 50 mg/day was administered for 12 months and the whole evaluation was repeated.


RESULTS
Sertraline was associated with fewer ventricular extrasystoles per 24 hours and a significant change in HRV (increase in mean R-R, 5-minute standard deviation of RR intervals, and root mean-square difference of successive RR intervals, and reduction in ultra and very low frequency). It was also followed by an improvement in patients' QoL. A trend toward a decrease was observed in the number of recalled nonsustained VTs. The episodes of sustained VT were not significantly reduced. Ventricular ERPs and VT inducibility remained unaltered.


CONCLUSIONS
In clinically stable, nondepressive patients with ischemic HF and ICD, sertraline is associated with reduced ventricular extrasystoles, better QoL, and a possible improvement in some HRV indexes. This suggests that SSRIs may have a favorable clinical impact on these patients, independent of the improvement in depressive symptoms.
Leftheriotis
Dionyssios
D
Department of Cardiology Department of Psychiatry, Attikon University Hospital of Athens, 1 Riministr., Haidari, Athens, Greece. dleftheriotis@yahoo.com
Flevari
Panayota
P
Ikonomidis
Ignatios
I
Douzenis
Athanasios
A
Liapis
Chrisovalandis
C
Paraskevaidis
Ioannis
I
Iliodromitis
Efstathios
E
Lykouras
Lefteris
L
Kremastinos
Dimitrios Th
DT
D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D017147:Defibrillators, Implantable; D003863:Depression / Q000523:psychology; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000209:etiology* / Q000523:psychology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D011788:Quality of Life; D012032:Refractory Period, Electrophysiological / Q000187:drug effects; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D020280:Sertraline / Q000627:therapeutic use*; D017180:Tachycardia, Ventricular / Q000188:drug therapy; D016896:Treatment Outcome; D018879:Ventricular Premature Complexes / Q000188:drug therapy
D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline