Abstract 12132: Risk for Cardiac Events in Long QT Syndrome Patients Treated With Antidepressants
Background: Current literature on the effect of antidepressant treatment on the clinical outcome of Long QT Syndrome (LQTS) patients is limited. It is well known that tricyclic antidepressants (TCAs) are associated with QTc prolongation. However, it is unclear how other newer antidepressants may affect the electrophysiology in patients with heart conditions such as LQTS.
Methods: Patients in this study were from the Rochester-based LQTS Registry. We hypothesized that the clinical course of LQTS patients being treated with non-TCA antidepressants (SSRI’s, SNRI’s, MAOI’s, serotonin modulators, and atypical antidepressants) would be complicated by more cardiac events compared to LQTS patients who have never used antidepressants (respectively, n=315 and n=2364). Kaplan-Meier and Cox proportional hazards regression analyses were used to evaluate risk of cardiac event (syncope, aborted cardiac arrest, and sudden cardiac death) in the study population.
Results: During the average of26.1± 15.6 years of follow-up, there was a 60% cumulative probability of occurrence of cardiac events in the antidepressant treatment group compared to 35% in the LQTS group not exposed to antidepressants (p≤0.001 [Figure]). Time-dependent use of non-TCA antidepressants was associated with an increased riskfor cardiac events (HR=1.63; 95% CI 1.01-2.50; p= 0.03), predominated by syncope, in the multivariate Cox model adjusting for gender, time-dependent β-blocker use, baseline QTc>500ms, prior cardiac events, interaction variables, and age-stratified by decade of birth. Similar results were seen in subgroups of LQTS patients exposed to antidepressants compared to those who have not: females (HR=1.74, p=0.02), genetically confirmed LQTS patients (HR=1.18, p=0.04), and specifically LQT2 patients (HR=2.26, p=0.04).
Conclusion: There is an increased risk for cardiac event occurrence in LQTS patients who use non-TCA antidepressants.
- © 2013 by American Heart Association, Inc.