Department of Cardiology, The Unit for Inherited Cardiac Diseases, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark.
Psychiatric Centre Copenhagen and Department of Neuroscience and Pharmacology, University of Copenhagen, Denmark.
Eur Heart J. 2014 May 21;35(20):1306-15. doi: 10.1093/eurheartj/ehu100. Epub 2014 Mar 18.
Several drugs used in the treatment of mental diseases are associated with an increased risk of sudden cardiac death (SCD). A general cause-relationship between the intake of these drugs and SCD is unattainable, but numerous case reports of drug-induced malignant arrhythmia and epidemiological studies, associating the use of specific drugs with SCD, strongly support the presence of an increased risk. Whereas the absolute risk of drug-induced life-threatening arrhythmia may be relatively low, even small increments in risk of SCD may have a major health impact considering that millions of patients are treated with psychotropics. In subgroups of pre-disposed patients, e.g. patients with cardiac diseases or other co-morbidities, the elderly or patients treated with other negatively interacting drugs, the absolute risk of drug-induced arrhythmia may be considerable. On the other hand, several of the major mental disorders are associated with a large risk of suicide if untreated. The observed risk of malignant arrhythmia associated with treatment with psychotropic drugs calls for clinical guidelines integrating the risk of the individual drug and other potentially interacting risk factors. In this review, data from various authorities on the risk of arrhythmia associated with psychotropic medications were weighted and categorized into three risk categories. Additionally, we suggest a clinically applicable algorithm to reduce the risk of malignant arrhythmia in patients to be treated with psychotropic medications. The algorithm integrates the risk categories of the individual drugs and pre-disposing risk factors and suggests a prudent follow-up for patients with an increased risk. We believe this clinically manageable guideline might improve safety in the many and rapidly increasing number of patients on psychotropic drugs.
一些用于治疗精神疾病的药物与心脏性猝死（SCD）的风险增加有关。这些药物的摄入与 SCD 之间一般没有因果关系，但大量药物引起恶性心律失常的病例报告和将特定药物与 SCD 相关联的流行病学研究强烈支持风险增加的存在。虽然药物引起危及生命的心律失常的绝对风险可能相对较低，但考虑到数百万患者接受精神药物治疗，SCD 风险的微小增加也可能对健康产生重大影响。在易患患者亚组中，例如患有心脏病或其他合并症、老年人或同时接受其他相互作用药物治疗的患者，药物引起心律失常的绝对风险可能相当大。另一方面，如果不治疗，几种主要的精神障碍与自杀的高风险相关。观察到与使用精神药物治疗相关的恶性心律失常的风险要求整合个体药物和其他潜在相互作用风险因素的风险指南。在这篇综述中，我们权衡了来自不同权威机构的与精神药物相关的心律失常风险数据，并将其分类为三个风险类别。此外，我们建议了一种临床适用的算法，以降低接受精神药物治疗的患者恶性心律失常的风险。该算法整合了个体药物的风险类别和易患风险因素，并为风险增加的患者提出了谨慎的随访建议。我们相信，这种具有临床管理能力的指南可能会提高接受精神药物治疗的大量且快速增加的患者的安全性。
