Vieweg W Victor R, Wood Mark A
Department of Psychiatry, Cardiology Division, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA 23238-5414, USA.
Psychosomatics. 2004 Sep-Oct;45(5):371-7. doi: 10.1176/appi.psy.45.5.371.
The authors postulate mechanisms linking tricyclic antidepressants, QT interval prolongation, torsade de pointes, and sudden cardiac death. Case reports identify amitriptyline and maprotiline as the tricyclic antidepressants most likely to provoke torsade de pointes. Risk factors of family history of congenital long QT syndrome, age, female sex, metabolic and cardiovascular disease, metabolic inhibitors, hypokalemia, drug overdose, and co-prescription of drugs associated with QT interval prolongation were found in cases of torsade de pointes associated with tricyclic antidepressants. Clinicians should be cautious when prescribing tricyclic antidepressants with other drugs, such as thioridazine, that are capable of prolonging the QT interval.
作者们推测了将三环类抗抑郁药、QT间期延长、尖端扭转型室速和心源性猝死联系起来的机制。病例报告表明，阿米替林和马普替林是最有可能引发尖端扭转型室速的三环类抗抑郁药。在与三环类抗抑郁药相关的尖端扭转型室速病例中，发现了先天性长QT综合征家族史、年龄、女性、代谢和心血管疾病、代谢抑制剂、低钾血症、药物过量以及与QT间期延长相关药物的联合处方等危险因素。临床医生在开具三环类抗抑郁药与其他能够延长QT间期的药物（如硫利达嗪）合用时应谨慎。
