PREVALENCE OF VENTRICULAR REPOLARIZATION ABNORMALITIES IN SUBJECTS ON PSYCHOTROPIC DRUGS IN NIGERIA: A CROSS-SECTIONAL COMPARATIVE STUDY
Main Article Content
Abstract
Introduction: Patients on psychotropic medications are at high risk of cardiac adverse effects and sudden death. However, the adverse effect burden of these drugs is grossly underreported in most African countries including Nigeria. The study aimed to evaluate the prevalence of ventricular repolarization electrocardiographic abnormalities (QTc, QTd, TpTe, and TpTe/QT) among patients taking psychotropics.
Methods: This study was conducted among 150 psychiatric patients on psychotropics and 75 controls. All subjects had resting electrocardiogram. QTc was determined using Bazett formula, QT dispersion was determined by subtracting shortest from longest QT in a 12-lead ECG, and Tpeak to Tend was measured from Tpeak to Tend in V5.
Results: The prevalence of prolonged QTc and QT dispersion in patients were significantly higher than the controls (24.7% vs. 4%; p<0.001 and 17.3% vs. 1.3%; p<0.001 respectively). The mean QTc and QT dispersion were significantly higher than the control group (418.5±28.1 ms vs 390.4±21.9ms; p<0.001 and 53.17±23.1ms vs. 43.7113.4ms; p=0.001 respectively). There was no statistically significant difference in the mean TpTe and TpTe/QT in both study groups.
Conclusion: Psychotropic drugs influence QTc and QT dispersion prolongation. This study showed that chronic use of psychotropics is associated with increased risk of ventricular repolarization abnormalities among this population.
Downloads
Article Details
Issue
Section
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
How to Cite
Share
References
1.Marano G, Traversi G, Romagnoli E et al. Cardiologic side effects of psychotropic drugs. Journal of Geriatric Cardiology: JGC. 2011; 8(4):243-253.
2.Waddington JL, Youssef HA, Kinsella A. Mortality in schizophrenia: antipsychotic polypharmacy and absence of adjunctive anticholinergics over the course of a 10-year prospective study. The British Journal of Psychiatry. 1998; 173(4):325-329.
3.Ruschena D, Mullen PE, Burgess P et al. Sudden death in psychiatric patients. The British Journal of Psychiatry. 1998; 172(4):331-336.
4.Mackin P. Cardiac side effects of psychiatric drugs. Hum Psychopharmacol. 2008; 23 Suppl 1:3-14. doi:10.1002/hup.915
5.Haddad PM, Anderson IM. Antipsychotic-related QTc prolongation, torsade de pointes and sudden death. Drugs. 2002; 62(11):1649-1671.
6.Wellens HJ, Schwartz PJ, Lindemans FW et al. Risk stratification for sudden cardiac death: current status and challenges for the future. European Heart Journal. 2014; 35(25):1642-1651.
7.Vieweg WV, Wood MA, Fernandez A, Beatty-Brooks M, Hasnain M, Pandurangi AK. Proarrhythmic risk with antipsychotic and antidepressant drugs. Drugs & Aging. 2009; 26(12):997-1012.
8.Dinshaw L, Münch J, Dickow J et al. The T-peak-to-T-end interval: a novel ECG marker for ventricular arrhythmia and appropriate ICD therapy in patients with hypertrophic cardiomyopathy.. Clin Res Cardiol.. 2018, 107:130-137. 10.1007/s00392-017-1164-4
9.Acciavatti T, Martinotti G, Corbo M et al. Psychotropic drugs and ventricular repolarisation: The effects on QT interval, T-peak to T-end interval and QT dispersion. Journal of Psychopharmacology. 2017; 31(4):453-460.
10.Gupta P, Patel C, Patel H et al. (2008) T(p-e)/QT ratio as an index of arrhythmogenesis. J Electrocardiol 41: 567-574.
11.Abdulmalik, J, Fadahunsi W, Kola L et al. (2014). The Mental Health Leadership and Advocacy Program (mhLAP): A pioneering response to the neglect of mental health in Anglophone West Africa. International Journal of Mental Health Systems.8 (5). https://doi.org/10.1186/1752-4458-8-5
12.World Health Organization, WHO. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. World Health Organization; 1992.
13.Kolo PM, Ajiboye PO, Yusuf AD, Omotoso AB, Okoro EO. Psychotropic Medications and QTc Parameters in a Nigerian Cohort. British Journal of Medicine and Medical Research. 2012; 2(3):434-443.
14.Kligfield P, Gettes LS, Bailey JJ et al. Recommendations for the standardization and interpretation of the electrocardiogram: part I: the electrocardiogram and its technology a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society endorsed by the International Society for Computerized Electrocardiology. Journal of the American College of Cardiology. 2007;49 (10):1109-1127.
15.Mason JW, Hancock EW, Gettes LS. Recommendations for the standardization and interpretation of the electrocardiogram: part II: electrocardiography diagnostic statement list a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society Endorsed by the International Society for Computerized Electrocardiology. Journal of the American College of Cardiology. 2007; 49(10):1128-1135.
16.Rautaharju PM, Surawicz B, Gettes LS. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part IV: the ST segment, T and U waves, and the QT interval a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society Endorsed by the International Society for Computerized Electrocardiology. Journal of the American College of Cardiology. 2009; 53(11):982-991.
17.Bazett HC. An analysis of the time relations of electrocardiograms. Heart. 1920; 7:353-370.
18.Yamaguchi M, Shimizu M, Ino H et al. (2003) T wave peak to- end interval and QT dispersion in acquired long QT syndrome: a new index for arrhythmogenicity. Clin Sci (Lond) 105: 671-676.
19.Panikkath R, Reinier K, Uy-Evanado A et al. Prolonged Tpeak-to-Tend interval on the resting ECG is associated with increased risk of sudden cardiac death. Circulation: Arrhythmia and Electrophysiology. 2011; 4(4):441-447.
20.Ogunmola OJ, Oladosu YO, Olamoyegun MA. QTC interval prolongation in HIV-negative versus HIV-positive subjects with or without antiretroviral drugs. Ann Afr Med. 2015; 14:169-176.
21.Morganroth J. Relations of QTc prolongation on the electrocardiogram to torsades de pointes: Definitions and mechanisms. Am J Cardiol. 1993; 72:10B-3.
22.Roden DM, Anderson ME. Proarrhythmia. Handb Exp Pharmacol. 2006; 171:73-97.
23.Zareba W, Lin DA. Antipsychotic drugs and QT interval prolongation. Psychiatric Quarterly. 2003; 74: 291-306.
24.Moosa MY, Jeenah FY, Mouton C. ECG changes in patients on chronic psychotropic medication. South African Journal of Psychiatry. 2006; 12(3):42-46.
25.Makkar RR, Fromm BS, Steinman RT, Meissner MD, Lehmann MH. Female gender as a risk factor for torsade de pointes associated with cardiovascular drugs. JAMA. 1993; 270: 2590–2597.
26.Shuba YM, Degtiar VE, Osipenko VN, Naidenov VG, Woosley RL. Testosterone-Mediated Modulation of HERG Blockade by Proarrhythmic Agents. Biochemical Pharmacology. 2001; 62:41-49.
27.Smetana P, Batchvarov V, Hnatkova K, Camm AJ, Malik M. Sex differences in the rate dependence of the T wave descending limb. Cardiovascular Research. 2003; 58(3):549–554.
28.Nakagawa M, Takahashi N, Watanabe M et al. Gender differences in ventricular repolarization: Terminal T wave interval was shorter in women than men. Pacing and Clinical Electrophysiology. 2003; 26:59-64