Psychiatry Investig.  2019 Feb;16(2):159-166. 10.30773/pi.2018.12.11.

Investigation of the Proarrhythmic Effects of Antidepressants according to QT Interval, QT Dispersion and T Wave Peak-to-End Interval in the Clinical Setting

• Okayasu H
• Ozeki Y
• Fujii K
• Takano Y
• Shinozaki
• Ohrui M
• Shimoda K

• KMID: 2440628
• DOI: http://doi.org/10.30773/pi.2018.12.11

Abstract

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.

Keyword

Antidepressants; Sudden cardiac death; QT prolongation; QT dispersion; T peak-to-end; Arrhythmia

MeSH Terms

Antidepressive Agents*
Arrhythmias, Cardiac
Clomipramine
Death, Sudden, Cardiac
Humans
Mianserin
Mood Disorders
Risk Factors
Antidepressive Agents
Clomipramine
Mianserin