Key result
Patients who developed ventricular arrhythmias following citalopram or escitalopram intoxication had significantly lower QRS/QTc ratios compared to those who did not (0.15 vs 0.24).
Why the study?
Supratherapeutic concentrations of citalopram are common and pose a risk for fatal ventricular arrhythmias like torsades de pointes, making identification of patients at risk clinically valuable.
Systematic Review (n=16)
Absolute Event Rate: 0.15% vs 0.24%
p-value: p=<0.0005
The QRS/QTc ratio is a promising novel ECG marker to predict the risk of ventricular arrhythmias in patients with citalopram or escitalopram intoxication.
May aid ventricular arrhythmia risk stratification in citalopram/escitalopram intoxication; extends observational ECG marker data but requires prospective validation.
Background: The U.S. Food and Drug Administration (FDA) has stated that citalopram and escitalopram should not be used at daily doses above 40 mg/20 mg due to risk for development of fatal ventricular arrhythmias like torsade de pointes (TdP). Yet, supratherapeutic serum concentrations of citalopram are common and predicting patients at risk for TdP is of high clinical value. Accordingly, we investigated whether QRS/QTc; developed for predicting TdP in hypothermic patients could be used in citalopram intoxication. Methods: A total of 16 publications describing patients suffering from complications due to citalopram or escitalopram treatment, or intoxication with the same substances, were included after a systematic search. The main criterion for inclusion was admission ECG, either with given QRS and QTc values or with attached ECG-files that enabled calculation. Results: < 0.0005) lower values in patients displaying ventricular arrhythmias. Conclusion: Citalopram and escitalopram are extensively used in treatment of depressive disorders, and a large proportion of patients have supratherapeutic serum concentrations. Calculation of QRS/QTc in available case reports show that this novel ECG-marker has potential to predict patients at risk for developing ventricular arrhythmias.
No takes yet. Share an insight, caveat, or question.
Dietrichs et al. (2022) conducted a systematic review in Citalopram or escitalopram intoxication or complications (n=16). Citalopram or escitalopram intoxication vs. Patients without ventricular arrhythmias was evaluated on QRS/QTc ratio (p=<0.0005). Patients who developed ventricular arrhythmias following citalopram or escitalopram intoxication had significantly lower QRS/QTc ratios compared to those who did not (0.15 vs 0.24).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: