5 years ago

Risk of Cardiac Events Associated with Antidepressant Therapy in Patients with Long QT Syndrome

Long QT Syndrome (LQTS) patients are at a high risk for cardiac events. Many LQTS patients are treated with antidepressant drugs (ADs). We investigated the LQTS genotype specific risk of recurrent cardiac arrhythmic events (CAEs) associated with ADs therapy. The study included 59 LQT1 and 72 LQT2 patients from the Rochester-based LQTS Registry with QTc prolongation and a history of AD therapy. Using multivariate Anderson-Gill models we estimated the LQTS genotype specific risk of recurrent CAEs (ventricular tachyarrhythmias, aborted cardiac arrest, or sudden cardiac death) associated with time-dependent ADs. Specifically, we examined the risk associated with all ADs, SSRIs, and ADs classified on the CredibleMeds list (www.CredibleMeds.org) as “Conditional” or “Known risk of Torsades de pointe (TdP)”. After adjusting for baseline QTc, sex, and time-dependent beta blocker usage, there was an increased risk of recurrent CAEs associated with ADs in LQT1 patients (HR=3.00, 95%CI: 1.55-5.84, p=0.001), but not in LQT2 patients (HR=1.05, 95%CI: 0.56-1.99, p=0.872; LQT1 vs. LQT2 interaction, p<0.001). Similarly, LQT1 patients who were on SSRIs or ADs with “Known risk of TdP” had a higher risk of recurrent CAEs than those off all ADs, whereas there was no association in LQT2 patients. ADs with “Conditional risk of TdP” were not associated with the risk of recurrent CAEs in any of the groups. In conclusion, the risk of recurrent CAEs associated with time-dependent ADs is higher in LQT1 patients, but not in LQT2 patients. Results suggest a LQTS genotype-specific effect of ADs on the risk of arrhythmic events.

Publisher URL: www.sciencedirect.com/science

DOI: S0002914917316181

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