title: Effects of atomoxetine on heart rhythm in children and adolescents.
abstract: BACKGROUND
  The aim of this study was to examine the effects of atomoxetine on heart rhythm using 12-lead electrocardiography (ECG) and 24 h Holter monitoring.
  
  
  METHODS
  Children and adolescents who were diagnosed with attention deficit-hyperactivity disorder according to DSM-IV-TR were referred to a pediatric cardiology clinic for cardiologic examination before and after 4 or 5 weeks of atomoxetine treatment. Cardiac examination, complete blood count, biochemistry, thyroid function tests, 12-lead ECG and 24 h Holter monitoring were performed routinely in all patients. Each subject underwent 24 h Holter ECG monitoring before atomoxetine was started and after 4 or 5 weeks of effective dose atomoxetine treatment.
  
  
  RESULTS
  Forty-one patients were included in this prospective study. No statistically significant change was found in QT, QTc or QT interval dispersion or blood pressure before and after 4 or 5 weeks of atomoxetine treatment. There was a statistically significant increase in heart rate (both during the day and at night) and QRS duration, and a statistically significant decrease in P wave dispersion. Three patients had rhythm disturbances. All of these three patients were asymptomatic and none of these arrhythmias reached clinical significance.
  
  
  CONCLUSIONS
  Atomoxetine did not cause significant changes in ECG or Holter variables. In two patients, who had undiagnosed subclinical extrasystoles, extra beats were increased after 4th week of treatment, but still remained clinically insignificant. Before and after atomoxetine treatment, listening to the heart sounds for a longer time, may help clinicians to notice an extra beat. If an extra beat is identified then 24 Holter monitoring is recommended.
authors.affiliation: Department of Pediatric Cardiology, Istanbul Mehmet Akif Ersoy, Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul, Turkey.
authors.forename: Ibrahim Cansaran
authors.initials: IC
authors.lastname: Tanidir
authors.affiliation: Department of Child and Adolescent Psychiatry, Bakırköy State Hospital for Mental Health and Neurological Disorders, Istanbul, Turkey.
authors.forename: Canan
authors.initials: C
authors.lastname: Tanidir
authors.affiliation: Department of Pediatric Cardiology, Istanbul Mehmet Akif Ersoy, Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul, Turkey.
authors.forename: Erkut
authors.initials: E
authors.lastname: Ozturk
authors.affiliation: Department of Child and Adolescent Psychiatry, Bakırköy State Hospital for Mental Health and Neurological Disorders, Istanbul, Turkey.
authors.forename: Kayhan
authors.initials: K
authors.lastname: Bahali
authors.affiliation: Department of Child and Adolescent Psychiatry, Bakırköy State Hospital for Mental Health and Neurological Disorders, Istanbul, Turkey.
authors.forename: Hatice
authors.initials: H
authors.lastname: Gunes
authors.affiliation: Department of Pediatric Cardiology, Istanbul Mehmet Akif Ersoy, Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul, Turkey.
authors.forename: Yakup
authors.initials: Y
authors.lastname: Ergul
authors.affiliation: Department of Child and Adolescent Psychiatry, Bakırköy State Hospital for Mental Health and Neurological Disorders, Istanbul, Turkey.
authors.forename: Ozden Sukran
authors.initials: OS
authors.lastname: Uneri
authors.affiliation: Department of Pediatric Cardiology, Istanbul Mehmet Akif Ersoy, Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul, Turkey.
authors.forename: Celal
authors.initials: C
authors.lastname: Akdeniz
authors.affiliation: Department of Pediatric Cardiology, Istanbul Mehmet Akif Ersoy, Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul, Turkey.
authors.forename: Volkan
authors.initials: V
authors.lastname: Tuzcu
mesh_terms: D000293:Adolescent; D018759:Adrenergic Uptake Inhibitors / Q000008:administration & dosage; D000069445:Atomoxetine Hydrochloride / Q000008:administration & dosage*; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D002648:Child; D004334:Drug Administration Schedule; D004562:Electrocardiography / Q000187:drug effects*; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018759:Adrenergic Uptake Inhibitors; D000069445:Atomoxetine Hydrochloride
keywords: Holter monitor; arrhythmia; atomoxetine; attention deficit-hyperactivity disorder; autonomic system