Key result
Various antipsychotics correlated with ECG proarrhythmic markers, and all indexes differed significantly between 235 matched schizophrenia patients and 235 healthy controls.
Why the study?
Antipsychotics are linked to QT prolongation and sudden cardiac death, but the QT interval is an imperfect proarrhythmic marker, prompting evaluation of newer ECG markers.
Do antipsychotic medications alter arrhythmogenic ECG parameters beyond QTc in patients with schizophrenia compared to healthy controls?
Observational (n=645)
Do antipsychotic medications alter arrhythmogenic ECG parameters beyond QTc in patients with schizophrenia compared to healthy controls?
Antipsychotic medications are associated with alterations in multiple arrhythmogenic ECG parameters beyond just QTc, suggesting that a comprehensive ECG evaluation may be necessary to assess the risk of sudden cardiac death in schizophrenia patients.
Multiple ECG markers warrant assessment in antipsychotic users; leaves open whether specific agents confer proarrhythmic risk beyond QTc.
PURPOSE: Antipsychotic drugs 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 marker for proarrhythmic risk. Recently, improved methods, namely, QT dispersion (QTD), QTD ratio (QTDR), T wave peak-to-end interval (Tp-e), Tp-e/QT ratio and Tp-e/QTc ratio, have been regarded as proarrhythmic risk markers. We attempted to reevaluate the risk of sudden cardiac death due to antipsychotics use by measuring these improved evaluation methods. PATIENTS AND METHODS: We retrospectively evaluated QTc, QTD, QTDR, Tp-e, Tp-e/QT ratio and Tp-e/QTc ratio from the medical records of 410 patients with schizophrenia diagnosed by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision, or 5th Edition. Information on drugs administered was obtained from medical records. We investigated the correlation between each index on ECG and medication, such as antipsychotics, prescribed to participants with linear regression analysis. We also compared each index between 235 healthy controls and 235 patients matched for age and sex. RESULTS: Positive correlations between QTc and levomepromazine and brexpiprazole were identified. Levomepromazine and lithium were positively correlated with QTD. Levomepromazine, quetiapine, asenapine, clozapine and carbamazepine were positively correlated with QTDR. Levomepromazine, olanzapine, brexpiprazole and lithium were positively correlated with Tp-e. Olanzapine, brexpiprazole and lithium were positively correlated with the Tp-e/QT ratio. Olanzapine, brexpiprazole and lithium were positively correlated with Tp-e/QTc ratio. Significant differences in all indexes were noted between the patients and healthy controls. CONCLUSION: According to our results, the prediction of the risk of sudden cardiac death by each index was inconsistent. We should evaluate the predictive factor of ventricular arrhythmia according to various electrocardiogram indexes because QTc alone could not identify the risk of sudden cardiac death.
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Okayasu et al. (2021) conducted an observational in Schizophrenia (n=645). Antipsychotics vs. Healthy controls was evaluated on ECG proarrhythmic risk markers (QTc, QTD, QTDR, Tp-e, Tp-e/QT ratio, Tp-e/QTc ratio). Various antipsychotics correlated with ECG proarrhythmic markers, and all indexes differed significantly between 235 matched schizophrenia patients and 235 healthy controls.
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