Key result
Clozapine combination, clozapine alone, olanzapine, and aripiprazole significantly decreased heart rate variability indices at 2 and 4 weeks compared to pretreatment (P<0.05).
Why the study?
Many antipsychotics have cardiac side effects, and heart rate variability (HRV) can indicate cardiotoxicity, prompting evaluation of the effects of 6 antipsychotic regimens on short-term HRV in schizophrenia.
Do different antipsychotic drug regimens affect short-term heart rate variability in patients with schizophrenia?
Observational (n=164)
Do different antipsychotic drug regimens affect short-term heart rate variability in patients with schizophrenia?
p-value: p=<0.05
Clozapine (alone or in combination), olanzapine, and aripiprazole significantly reduce short-term heart rate variability in patients with schizophrenia, suggesting a need for ECG monitoring, whereas ziprasidone and risperidone do not.
Clozapine regimens associate with greater short-term HRV reduction than alternatives; leaves open whether this warrants routine ECG monitoring in schizophrenia.
Objective Many antipsychotic drugs have cardiac side effects. Heart rate variability (HRV) analysis can be used as a indicator of cardiotoxicity in cases where a decrease in HRV occurs after the administration of antipsychotics such as clozapine. The purpose of this study was to explore the effects of 6 antipsychotic drug regimens on short-term HRV in patients with schizophrenia. Methods Data from 164 patients with schizophrenia between January 2018 and June 2023 were retrospectively analyzed. Based on the drug used for treatment, patients were categorized into clozapine combination (clozapine combined with aripiprazole, risperidone or ziprasidone), clozapine alone, olanzapine, aripiprazole, ziprasidone, and risperidone groups. Heart rate variability indices were calculated using time domain analysis, including the standard deviation of the RR intervals (SDNN), the root mean square of successive RR interval differences (RMSSD), and the percentage of successive RR intervals over 50 ms (PNN50). Results Compared with the pretreatment period, the SDNN, RMSSD, and PNN50 were significantly lower in the clozapine combination, clozapine, olanzapine and aripiprazole groups at the end of weeks 2 and 4 of treatment ( P < 0.05). However, those indicators in ziprasidone and risperidone groups did not show this decrease ( P > 0.05). Conclusion The effects of clozapine combination and clozapine on HRV were greater than for olanzapine, aripiprazole, ziprasidone, or risperidone. Attention should be paid to controlling the dose of clozapine combination and clozapine alone and monitoring the patient’s electrocardiogram during administration.
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Huang et al. (2024) conducted an observational in schizophrenia (n=164). Antipsychotic drug regimens (clozapine combination, clozapine alone, olanzapine, aripiprazole, ziprasidone, risperidone) vs. pretreatment period was evaluated on Short-term heart rate variability indices (SDNN, RMSSD, PNN50) (p=<0.05). Clozapine combination, clozapine alone, olanzapine, and aripiprazole significantly decreased heart rate variability indices at 2 and 4 weeks compared to pretreatment (P<0.05).
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