Fanoe Søren, Hvidt Christian, Ege Peter, Jensen Gorm Boje
Department of Cardiology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
Heart. 2007 Sep;93(9):1051-5. doi: 10.1136/hrt.2006.100180. Epub 2007 Mar 7.
Methadone is prescribed to heroin addicts to decrease illicit opioid use. Prolongation of the QT interval in the ECG of patients with torsade de pointes (TdP) has been reported in methadone users. As heroin addicts sometimes faint while using illicit drugs, doctors might attribute too many episodes of syncope to illicit drug use and thereby underestimate the incidence of TdP in this special population, and the high mortality in this population may, in part, be caused by the proarrhythmic effect of methadone.
In this cross-sectional study interview, ECGs and blood samples were collected in a population of adult heroin addicts treated with methadone or buprenorphine on a daily basis. Of the patients at the Drug Addiction Service in the municipal of Copenhagen, 450 (approximately 52%) were included. The QT interval was estimated from 12 lead ECGs. All participants were interviewed about any experience of syncope. The association between opioid dose and QT, and methadone dose and reporting of syncope was assessed using multivariate linear regression and logistic regression, respectively.
Methadone dose was associated with longer QT interval of 0.140 ms/mg (p = 0.002). No association between buprenorphine and QTc was found. Among the subjects treated with methadone, 28% men and 32% women had prolonged QTc interval. None of the subjects treated with buprenorphine had QTc interval >0.440 s((1/2)). A 50 mg higher methadone dose was associated with a 1.2 (95% CI 1.1 to 1.4) times higher odds for syncope.
Methadone is associated with QT prolongation and higher reporting of syncope in a population of heroin addicts.
美沙酮被开给海洛因成瘾者以减少非法阿片类药物的使用。有报道称，使用美沙酮的患者会出现尖端扭转型室性心动过速（TdP）心电图上QT间期延长的情况。由于海洛因成瘾者在使用非法药物时有时会昏厥，医生可能会将过多的昏厥发作归因于非法药物使用，从而低估了这一特殊人群中TdP的发生率，而该人群的高死亡率可能部分是由美沙酮的促心律失常作用导致的。
在这项横断面研究访谈中，收集了每日接受美沙酮或丁丙诺啡治疗的成年海洛因成瘾者的心电图和血样。在哥本哈根市药物成瘾服务中心的患者中，有450名（约52%）被纳入。从12导联心电图中估算QT间期。所有参与者都接受了关于昏厥经历的访谈。分别使用多元线性回归和逻辑回归评估阿片类药物剂量与QT之间以及美沙酮剂量与昏厥报告之间的关联。
美沙酮剂量与QT间期延长0.140毫秒/毫克相关（p = 0.002）。未发现丁丙诺啡与QTc之间存在关联。在接受美沙酮治疗的受试者中，28%的男性和32%的女性QTc间期延长。接受丁丙诺啡治疗的受试者中，没有QTc间期>0.440秒（1/2）的情况。美沙酮剂量每增加50毫克，昏厥几率就会高出1.2倍（95%置信区间1.1至1.4）。
在海洛因成瘾者群体中，美沙酮与QT间期延长和更高的昏厥报告率相关。
