Key result
Tricyclic antidepressant use, particularly clomipramine, was significantly associated with prolonged QTc and QT dispersion, but not with Tp-e or Tp-e/QT ratio.
Why the study?
The QT interval is considered an imperfect biomarker for proarrhythmic risk, prompting reevaluation of antidepressant-related sudden cardiac death risk using QT dispersion, T wave peak-to-end interval, and Tp-e/QT ratio.
Does antidepressant use increase proarrhythmic risk markers (QTc, QTD, Tp-e, Tp-e/QT ratio) in patients with mood disorders?
Observational (n=543)
Yes
Does antidepressant use increase proarrhythmic risk markers (QTc, QTD, Tp-e, Tp-e/QT ratio) in patients with mood disorders?
Effect estimate: PRC 9.56 (95% CI 4.72-14.4)
p-value: p=<0.05
Antidepressants, particularly clomipramine and mianserin, significantly prolong QTc and QT dispersion, suggesting QT dispersion may be a suitable marker for predicting sudden cardiac death risk in these patients.
TCA use was associated with QTc/QT dispersion prolongation in mood disorders; leaves open whether these markers predict arrhythmic events, needing prospective validation.
OBJECTIVE: Some antidepressants have been implicated as risk factors for QT prolongation, which is a predictor of sudden cardiac death. However, the QT interval is considered an imperfect biomarker for proarrhythmic risk. Therefore, we reevaluated the risk of sudden cardiac death due to antidepressants using improved. METHODS: , namely, QT dispersion (QTD), T wave peak-to-end interval (Tp-e), and Tp-e/QT ratio. METHODS: We compared the effects of antidepressants on QTc (QT/RR1/3), QTD, Tp-e, and Tp-e/QT ratio in 378 patients with mood disorder. We also compared each index between 165 healthy controls and 215 randomly selected age-matched patients. RESULTS: Age (p<0.01), sex (p<0.05), tricyclic antidepressant (TCA) use (p<0.05), and clomipramine (p<0.01) and mianserin (p<0.05) use in particular, significantly associated with a prolonged QTc. We also found that age (p<0.01), TCA use (p<0.05), and clomipramine (p<0.01) and mianserin (p<0.05) use in particular, significantly prolonged QTD. However, there was no correlation between each variable and Tp-e or Tp-e/QT ratio. Significant differences in QTc and QTD were found between the patients and healthy controls. CONCLUSION: From our results, prediction of risk of sudden cardiac death by QTD, Tp-e, or Tp-e/QT ratio was inconsistent. Increased QTD may be more suitable for predicting sudden cardiac death due to antidepressants.
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Okayasu et al. (2019) conducted an observational in Mood disorder (n=543). Antidepressants (including TCAs such as clomipramine) vs. Healthy controls / Non-users was evaluated on QTc interval prolongation (associated with TCA use) (PRC 9.56, 95% CI 4.72-14.4, p=<0.05). Tricyclic antidepressant use, particularly clomipramine, was significantly associated with prolonged QTc and QT dispersion, but not with Tp-e or Tp-e/QT ratio.
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