title: Electrocardiography changes in bipolar patients during long-term lithium monotherapy.
abstract: OBJECTIVE
  Cardiovascular side effects of lithium have been reported to occur mainly at higher-than-therapeutic serum levels. We aimed to investigate the impact of the long-term lithium use on electrocardiogram (ECG) parameters in association with the serum levels in patients with bipolar disorder (BD) and in healthy controls (HCs) serving as the reference group.
  
  
  METHODS
  The study sample consisted of 53 euthymic BD type I patients on lithium monotherapy at therapeutic serum levels (M = 0.76, S.D. = 0.14, range = 0.41-1.09 mmol/l) for at least 12 months and 45 HCs. A 12-lead surface ECG was obtained from all participants at resting state for at least half an hour for 5-min recording. Heart-rate, Pmax, Pmin, QRS interval, QT dispersion, QT dispersion ratio (QTdR) and Tpeak-to-end interval (TpTe) were measured.
  
  
  RESULTS
  Regression analyses revealed that QTdR (B = 14.17, P = .001), TpTe (B = 18.38, P < .001), Pmax (B = 17.84, P<.001) and Pmin (B = 25.10, P < .001) were increased in BD patients who were on chronic lithium treatment than in HCs after controlling for age, sex and strict Bonferroni correction for multiple testing. There were no associations between serum lithium levels and ECG parameters.
  
  
  CONCLUSIONS
  Our findings suggest that the use of lithium is associated with both atrial and ventricular electrical instability, even when lithium levels are in the therapeutic range.
authors.affiliation: Canakkale Onsekiz Mart University Faculty of Medicine, Department of Psychiatry, Canakkale, Turkey. Electronic address: kursataltinbas@gmail.com.
authors.forename: Kursat
authors.initials: K
authors.lastname: Altinbas
authors.affiliation: Yale University, Department of Psychiatry, New Haven, CT, USA; Department of Psychiatry and Psychology, Maastricht University Medical Centre, EURON, Maastricht, The Netherlands.
authors.forename: Sinan
authors.initials: S
authors.lastname: Guloksuz
authors.affiliation: Bakirkoy Sadi Konuk Research and Training Hospital, Department of Cardiology, Istanbul, Turkey.
authors.forename: Ilker Murat
authors.initials: IM
authors.lastname: Caglar
authors.affiliation: Istanbul Research and Training Hospital, Department of Cardiology, Istanbul, Turkey.
authors.forename: Fatma Nihan Turhan
authors.initials: FN
authors.lastname: Caglar
authors.affiliation: Rasit Tahsin Mood Clinic, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey.
authors.forename: Erhan
authors.initials: E
authors.lastname: Kurt
authors.affiliation: Istanbul University of Commerce, Department of Psychology, Istanbul,Turkey.
authors.forename: Esat Timucin
authors.initials: ET
authors.lastname: Oral
mesh_terms: D000328:Adult; D018692:Antimanic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D001145:Arrhythmias, Cardiac / Q000139:chemically induced* / Q000175:diagnosis*; D001714:Bipolar Disorder / Q000188:drug therapy*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D018020:Lithium Compounds / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D008297:Male; D008875:Middle Aged
chemical_list: D018692:Antimanic Agents; D018020:Lithium Compounds
keywords: Arrhythmia; Bipolar disorder; ECG; Lithium; QT interval