P171 EVALUATION OF ARRHYTHMIC RISK IN THE PSYCHOPHARMACOLOGIC–TREATED PATIENT

Abstract

Abstract Background Neuroleptics (NRL) and Tricyclic Antidepressants (TCA) could be related to the QT prolongation although the risk of ventricular arrhythmias and sudden death caused by these drugs was not clearly described in literature. Corrected QT (QTc), is the major marker of arrhythmic risk; Qt dispersion (QTd) is defined as the dispersion of the QT interval on 12–lead electrocardiogram (ECG) and is predictive of mortality if > 58; the heart rate variability (HRV) is indicative of the sympathetic/vagal tone and of the arrhythmic risk. Aim of the study. Evaluation of the main effects of psychotropic drugs in psychiatric patients on the following parameters: QT interval, QTc using 4 formulas (Bazett, Fridericia, Framingham e Hodges), Qtd and HRV depending on time and heart rate. Materials and Methods Data from 167 patients treated with typical and atypical NRL, TCA, and mood stabilizers have been collected. The observational study consisted in these phases: 1) chart review of 84 patients admitted in day hospital to detect sex, age, diagnosis, therapy and Qtc; 2) evaluation of the same parameters in 83 of them, to whom an ECG was performed at the discharge; 3) ECG Holter in a subgroup of 17 patients who have given consent to the exam, to highlith the incidence of arrhythmias and to investigate the HRV. Results No significant QTc alterations related to therapy were detected at the admission or at the discharge. Moreover, no statistically significant differences emerged among NRL classes nor an increased arrhythmic risk in polypharmacy. The use of different formulas has confirmed an overestimation of the QTc according to the Bazett formula. QTd was altered in 67 patients ( QTd ≥50 in 51 subjects; QTd>60 in 12 subjects)and the HRV was lower compared to the general population regardless of the therapies. Conclusions The psychopharmacological therapy in a “real world setting” didn’t show a signiticative influence on the evaluated parameters of arrhythmic risk. The arrhythmic risk is low in absence of other risk factors or comorbidities. QT correction using FRI or HOD, the QTd if QTc >450–470 ms and the HRV in patients with arrhythmic risk factors, should be considered as parameters to evaluate in the clinic routine of follow–up of psychopharmacologic–treated patient.