title: Long-QT Syndrome and Therapy for Attention Deficit/Hyperactivity Disorder.
abstract: BACKGROUND
  Stimulants are the mainstay therapy for attention deficit/hyperactivity disorder (ADHD) and are associated with adrenergic side effects. There are limited data on the clinical course of patients treated for ADHD who have long-QT syndrome (LQTS), for which β-blockade is the goal of therapy.
  
  
  METHODS
  LQTS patients from the Rochester-based LQTS Registry (open-enrollment between 1979 and 2003; follow-up from 1979 to present) treated with stimulant or nonstimulant ADHD medications (n = 48) were compared to a 2:1 age-, gender-, and QTc-duration matched LQTS control group not exposed to ADHD medications (n = 96). Kaplan-Meier and Cox proportional hazards regression analyses were used to evaluate risk of cardiac events (syncope, aborted cardiac arrest, and sudden cardiac death) in LQTS patients treated with ADHD medications.
  
  
  RESULTS
  During a mean follow-up of 7.9 ± 5.4 years after initiation of ADHD medication at a mean age 10.7 ±7.3 years, there was a 62% cumulative probability of cardiac events in the ADHD treatment group compared to 28% in the matched LQTS control group (P < 0.001). Time-dependent use of ADHD medication was associated with an increased risk for cardiac events (HR = 3.07; P = 0.03) in the multivariate Cox model adjusted for time-dependent β-blocker use and prior cardiac events. Subgroup gender analyses showed that time-dependent ADHD medication was associated with an increased risk in male LQTS patients (HR = 6.80, P = 0.04).
  
  
  CONCLUSIONS
  LQTS patients treated with ADHD medications have increased risk for cardiac events, particularly syncope, and this risk is augmented in males. The findings highlight the importance of heightened surveillance for LQTS patients on ADHD medications.
authors.affiliation: University of Rochester Medical Center, Heart Research Follow-Up Program, Rochester, New York.
authors.forename: Claire
authors.initials: C
authors.lastname: Zhang
authors.affiliation: University of Rochester Medical Center, Heart Research Follow-Up Program, Rochester, New York.
authors.forename: Valentina
authors.initials: V
authors.lastname: Kutyifa
authors.affiliation: University of Rochester Medical Center, Heart Research Follow-Up Program, Rochester, New York.
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Moss
authors.affiliation: University of Rochester Medical Center, Heart Research Follow-Up Program, Rochester, New York.
authors.forename: Scott
authors.initials: S
authors.lastname: McNitt
authors.affiliation: University of Rochester Medical Center, Heart Research Follow-Up Program, Rochester, New York.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Zareba
authors.affiliation: Metro Health Campus of Case Western Reserve University, Heart and Vascular Research Center, Cleveland, Ohio, USA.
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Kaufman
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D002648:Child; D015897:Comorbidity; D064420:Drug-Related Side Effects and Adverse Reactions / Q000401:mortality; D005260:Female; D006801:Humans; D008133:Long QT Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D008297:Male; D009518:New York / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D012042:Registries; D018570:Risk Assessment; D017678:Sex Distribution; D015996:Survival Rate; D013575:Syncope / Q000401:mortality*; D016896:Treatment Outcome
chemical_list: D000697:Central Nervous System Stimulants
keywords: adrenergic side effect; attention deficit hyperactivity disorder; congenital arrhythmia; long-QT syndrome; stimulants