Sutterland Arjen L, Blom Marieke T, Ladee Katinka, Lubbers Jorieke J M, Cohen Dan, de Haan Lieuwe, Tan Hanno L
Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Early Psychosis Section, Amsterdam, the Netherlands.
Amsterdam UMC, University of Amsterdam, Department of Cardiology, Heart Center, Amsterdam, the Netherlands.
Schizophr Res. 2019 Aug;210:59-65. doi: 10.1016/j.schres.2019.06.013. Epub 2019 Jun 24.
Schizophrenia is associated with an increased risk of sudden cardiac death, traditionally attributed to prolonged QTc interval and increased prevalence of cardiovascular risk factors. However, defective ion channels implicated in both schizophrenia and Brugada Syndrome (BrS) may be associated with an increased risk of cardiac arrhythmias. Moreover, these cardiac arrhythmias can be provoked by various drugs, including psychotropic drugs.
To assess the prevalence of the occurrence of ECG suspicious for BrS (suspect BrS-ECG) and the prevalence of BrS in patients with recent onset schizophrenia spectrum disorders (SSD).
In this case-control study, ECGs of 388 patients with recent onset SSD admitted between 2006 and 2015 and 844 healthy controls were made. All persons who had a suspect BrS-ECG were offered an ajmaline provocation test to diagnose or exclude BrS. Data on possible confounders were ascertained. Patients with and without suspect BrS-ECG were compared regarding clinical and ECG variables.
Suspect BrS-ECG was found in 33 patients (8.5%) and 13 healthy controls (1.5%), with an adjusted Odds Ratio of 3.5 (p < 0.0001). This finding was not explained by potential confounders such as gender, age, ethnicity, cannabis use, cardiovascular risk factors, medication use or serum electrolytes. BrS was confirmed in three patients and one control.
A considerable subset of patients with recent onset SSD have suspect BrS-ECG, extending earlier findings in patients with chronic schizophrenia. Screening for BrS in schizophrenia could be relevant both to prevent sudden cardiac death and to identify a subgroup of patients with possible ion-channel dysfunctioning.
精神分裂症与心源性猝死风险增加有关，传统上认为这归因于QTc间期延长和心血管危险因素患病率增加。然而，与精神分裂症和 Brugada 综合征（BrS）均相关的离子通道缺陷可能与心律失常风险增加有关。此外，包括精神药物在内的各种药物可诱发这些心律失常。
评估近期起病的精神分裂症谱系障碍（SSD）患者中疑似 BrS 的心电图（疑似 BrS-ECG）发生率及 BrS 患病率。
在这项病例对照研究中，对2006年至2015年间收治的388例近期起病的SSD患者和844例健康对照者进行了心电图检查。所有有疑似 BrS-ECG 的人均接受了阿义马林激发试验以诊断或排除 BrS。确定了可能的混杂因素数据。比较了有和没有疑似 BrS-ECG 的患者的临床和心电图变量。
33例患者（8.5%）和13例健康对照者（1.5%）发现有疑似 BrS-ECG，校正比值比为3.5（p<0.0001）。这一发现不能用性别、年龄、种族、大麻使用、心血管危险因素、药物使用或血清电解质等潜在混杂因素来解释。3例患者和1例对照者确诊为 BrS。
相当一部分近期起病的SSD患者有疑似 BrS-ECG，这扩展了慢性精神分裂症患者的早期研究结果。对精神分裂症患者进行 BrS 筛查可能与预防心源性猝死以及识别可能存在离子通道功能障碍的患者亚组有关。
