Department of Psychiatry and Behavioral Sciences, University of California at Davis School of Medicine, Sacramento, CA, United States of America.
Department of Behavioral Health, NYU Winthrop Hospital, Mineola, NY, United States of America.
J Psychosom Res. 2020 Aug;135:110138. doi: 10.1016/j.jpsychores.2020.110138. Epub 2020 May 11.
Several psychiatric medications have the potential to prolong the QTc interval and subsequently increase the risk for ventricular arrhythmias such as torsades de pointes (TdP). There is limited guidance for clinicians to balance the risks and benefits of treatments.
After a review of the existing literature, clinical-educators from the Association of Medicine and Psychiatry developed expert consensus guidelines for ECG monitoring of the QTc interval for patients with medical and psychiatric comorbidities who are prescribed medications with the potential to prolong the QTc interval. A risk score was developed based on risk factors for QTc prolongation to guide clinical decision-making.
A baseline ECG may not be necessary for individuals at low risk for arrythmia. Those individuals with a risk score of two or more should have an ECG prior to the start of a potentially QTc-prolonging medication or be started on a lower risk agent. Antipsychotics are not equivalent in causing QTc prolongation. A consensus-based algorithm is presented for the management of those identified at high (QTc >500 msec), intermediate (males with QTc 450-499 msec or females with QTc > 470-499 msec), or low risk.
The proposed algorithm can help clinicians in determining whether ECG monitoring should be considered for a given patient. These guidelines preserve a role for clinical judgment in selection of treatments that balance the risks and benefits, which may be particularly relevant for complex patients with medical and psychiatric comorbidities. Additional studies are needed to determine whether baseline and serial ECG monitoring reduces mortality.
一些精神科药物有可能延长 QTc 间期，从而增加尖端扭转型室性心动过速（TdP）等室性心律失常的风险。临床医生在权衡治疗风险和益处方面的指导有限。
在对现有文献进行回顾后，医学与精神病学协会的临床教育者为合并有医学和精神疾病且正在服用可能延长 QTc 间期的药物的患者制定了 QTc 间期心电图监测的专家共识指南。根据 QTc 延长的危险因素制定了风险评分，以指导临床决策。
对于心律失常风险低的个体，基线心电图可能不是必需的。风险评分为 2 分或更高的个体，在开始使用可能延长 QTc 的药物之前，或开始使用风险较低的药物之前，应进行心电图检查。抗精神病药物在引起 QTc 延长方面并非等效。提出了一种基于共识的算法，用于管理那些被确定为高风险（QTc > 500 msec）、中风险（男性 QTc 450-499 msec 或女性 QTc > 470-499 msec）或低风险的患者。
拟议的算法可以帮助临床医生确定是否应考虑对特定患者进行心电图监测。这些指南在治疗选择中保留了临床判断的作用，以平衡风险和益处，这对于合并有医学和精神疾病的复杂患者可能特别重要。需要进一步的研究来确定基线和连续心电图监测是否可以降低死亡率。
