Trojak Benoit, Pinoit Jean-Michel, André Denis, Bonin Bernard, Gisselmann André
Service de Psychiatrie et d'Addictologie, CHU de Dijon.
Presse Med. 2006 Apr;35(4 Pt 2):699-704. doi: 10.1016/s0755-4982(06)74665-6.
Torsades de pointes (TdP), a form of ventricular arrhythmia that can cause ventricular fibrillation and sudden death, may occur during prolongation of the QT interval. QT prolongation has recently been reported with antipsychotic drugs. Physicians should be able to obtain a corrected measurement of the QT interval. QT is measured from the beginning of the QRS complex to the end of the T wave (QTm). This value must then be corrected to take heartbeat into account. The most common formula in current use is Bazett's. In practice, a QTc interval value greater than 500 ms indicates an increased risk of TdP. Safe combinations of antipsychotic drugs have been recommended by the French drug agency (Agence française de sécurité sanitaire des produits de santé). Many other drugs, including psychotropic drugs such as tricyclic antidepressants, can prolong the QT interval. Combinations of these medications with one another, with antipsychotic medications, or with other concomitant factors, such as hypokalemia, also increase the risk. TdP is most often diagnosed only after observing QT prolongation. This underlines the need to monitor QT intervals attentively to prevent the risk of cardiac arrhythmia in patients treated with antipsychotic drugs.
尖端扭转型室性心动过速（TdP）是一种可导致心室颤动和猝死的室性心律失常，可能在QT间期延长时发生。最近有报道称抗精神病药物可导致QT间期延长。医生应能够获得QT间期的校正测量值。QT是从QRS波群开始到T波结束进行测量（QTm）。然后必须对该值进行校正以考虑心跳因素。目前最常用的公式是Bazett公式。实际上，QTc间期值大于500毫秒表明TdP风险增加。法国药品安全局（法国卫生安全产品局）已推荐了抗精神病药物的安全组合。许多其他药物，包括三环类抗抑郁药等精神药物，也可延长QT间期。这些药物相互之间、与抗精神病药物或与其他伴随因素（如低钾血症）联合使用时，也会增加风险。TdP通常仅在观察到QT间期延长后才被诊断出来。这凸显了在使用抗精神病药物治疗的患者中密切监测QT间期以预防心律失常风险的必要性。
