title: Antipsychotic drugs and the risk of ventricular arrhythmia and/or sudden cardiac death: a nation-wide case-crossover study.
abstract: BACKGROUND
  Antipsychotics have been linked to prolongation of the QT interval. However, little is known about the risk of ventricular arrhythmia (VA) and/or sudden cardiac death (SCD) associated with individual antipsychotic drug use. This study was designed to investigate the association between specific antipsychotic drugs and the risk of VA and/or SCD.
  
  
  RESULTS
  We conducted a case-crossover study using a nation-wide population-based sample obtained from Taiwan's National Health Insurance Research Database. A total of 17 718 patients with incident VA and/or SCD were enrolled. Conditional logistic regression models were applied to examine the effects of antipsychotic drug use on the risk of VA/SCD during various case and control time windows of 7, 14, and 28 days. The effect of the potency of a human ether-à-go-go-related gene (hERG) potassium channel blockade was also assessed. Antipsychotic drug use was associated with a 1.53-fold increased risk of VA and/or SCD. Antipsychotic drugs with increased risk included clothiapine, haloperidol, prochlorperazine, thioridazine, olanzapine, quetiapine, risperidone, and sulpiride. The association was significantly higher among those with short-term use. Antipsychotics with a high potency of the hERG potassium channel blockade had the highest risk of VA and/or SCD.
  
  
  CONCLUSIONS
  Use of antipsychotic drugs is associated with an increased risk of VA and/or SCD. Careful evaluations of the risks and benefits of antipsychotic treatment are highly recommended.
authors.affiliation: Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan (C.S.W.) College of Public Health, National Taiwan University, Taipei, Taiwan (C.S.W.) Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan (C.S.W.).
authors.forename: Chi-Shin
authors.initials: CS
authors.lastname: Wu
authors.affiliation: Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan (Y.T.T., H.J.T.).
authors.forename: Yu-Ting
authors.initials: YT
authors.lastname: Tsai
authors.affiliation: Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan (Y.T.T., H.J.T.) Department of Public Health, China Medical University, Taichung, Taiwan (H.J.T.) Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL (H.J.T.).
authors.forename: Hui-Ju
authors.initials: HJ
authors.lastname: Tsai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001145:Arrhythmias, Cardiac / Q000139:chemically induced* / Q000453:epidemiology; D018592:Cross-Over Studies; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology*; D051638:Ether-A-Go-Go Potassium Channels / Q000037:antagonists & inhibitors*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D026902:Potassium Channel Blockers / Q000008:administration & dosage / Q000009:adverse effects*; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D051638:Ether-A-Go-Go Potassium Channels; D026902:Potassium Channel Blockers
keywords: antipsychotics; sudden cardiac death; ventricular arrhythmia