Abstract 19626: Sudden Cardiac Arrest Risk of Non-Cardiac Depolarization-Blocking Drugs
Introduction: Drugs may increase risk of ventricular tachycardia/fibrillation (VT/VF) and sudden cardiac arrest (SCA) in susceptible individuals by blocking cardiac ion channels. This also applies to drugs prescribed for non-cardiac conditions (non-cardiac drugs) if these drugs possess such properties. A well-known example is non-cardiac drugs that block cardiac potassium channels and cardiac repolarization. These drugs may cause excessive QT-interval prolongation and VT/VF in individuals with reduced repolarization reserve (e.g., Long QT syndrome). Similarly, non-cardiac drugs that block cardiac sodium channels and cardiac depolarization increase VT/VF risk in individuals with reduced depolarization reserve (e.g., Brugada syndrome). We hypothesized that non-cardiac depolarization blocking drugs (DB-drugs) are associated with increased VT/VF risk in the general population.
Methods and results: A community based case-control study was performed. Cases were out-of-hospital SCA victims with documented VT/VF included in the ARREST study in June 2005 - December 2009. Controls were age/sex/SCA-date matched non-SCA individuals from the PHARMO database, which contains complete drug dispensing records from community pharmacies. Multivariate conditional regression analysis was used to assess the association between SCA and non-cardiac DB-drugs.
We included 1787 SCA cases (mean age 66 years, 77% male) and matched them to 7666 non-SCA controls. Non-cardiac DB-drugs were used by 81 cases (4.5%) and 249 controls (3.2%), and were associated with a 41% increased SCA risk (ORadj: 1.41 [95% CI: 1.10-1.83] P<0.05). Use of two or more DB-drugs was associated with a 5.6-fold risk (OR: 5.63 [1.95-16.23] P<0.05). When stratified according to acute myocardial infarct (AMI) status, SCA risk only appeared elevated in patients in whom the SCA resulted from AMI (ORAMI 1.41 [0.91-2.16]); ORnon-AMI 1.12 [0.62-2.03]). However, when stratified the association did not reach statistical significance.
Conclusion: Current use of non-cardiac DB-drugs is associated with increased risk of SCA, especially when two or more DB-drugs are used simultaneously.
Author Disclosures: M.T. Blom: None. E. Eke: None. D.A. van Hoeijen: None. P.C. Souverein: None. A. de Boer: None. H.L. Tan: None.
- © 2016 by American Heart Association, Inc.