Golibkhon Azamatov, Akbar Gafur Ugli Bazarbaev, Makhamadjonov Farkhod Ugli Muzaffar
Department of General Internal Medicine, Almalyk City Central Family Outpatient Hospital, Almalyk, UZB.
Department of Medicine, Tashkent Medical Academy, Tashkent, UZB.
Cureus. 2023 Apr 23;15(4):e38007. doi: 10.7759/cureus.38007. eCollection 2023 Apr.
Opioids are compounds that cause similar effects to morphine by binding to its receptors. Opioids can be synthetic, semi-synthetic, or natural and can easily bind to the receptors of opioids in order to depict their effects, which may vary depending upon the exposure of the drug and its dose. However, several side effects of opioids can also be observed, with the most crucial being their impact on the heart's electrical activity. This review majorly focuses on opioids' impact on the prolongation of the QT curve and their arrhythmogenic susceptibility. Articles published up to the year 2022 in various databases were identified and searched with the use of keywords. Search terms included "cardiac arrhythmias," "QT interval," "opioids," "opioid dependence," and "torsade de pointes (TdP)". These terms highlight the impact of each opioid agent on the activity of the heart on an electrocardiogram. The results of the available data depict that opioids, such as methadone, pose higher risks, even when taken in smaller amounts, and have the capability for QT interval prolongation and TdP development. A variety of opioids, i.e., oxycodone and tramadol, are considered as intermediary risk drugs and can build long QT intervals and TdP in large doses. Several other opioids are considered low-risk drugs, including buprenorphine and morphine, which lead to no production of TdP and QT interval prolongation in daily routine doses. Evidence indicates a high risk of sinus bradycardia, atrial fibrillation, cardiac block, and supra-ventricular arrhythmias in opium consumers. This literature review will play a key role in determining the association between the use of opioids and cardiac arrhythmias. It will further highlight the practical implications of opioids for the management of cardiac issues based on their dose, frequency, and intensity. Moreover, it will also depict the adverse effects of opioids along with their dose-specific relationship. Opioids display disparate cardiac arrhythmogenicity, and methadone contains a greater ability to induce long QT intervals and hazardous arrhythmias at conventional doses. In order to reduce arrhythmogenic risk, opioids taken in large amounts should be monitored with a regular electrocardiogram in high-risk consumers, i.e., patients on opioid maintenance.
阿片类药物是一类通过与吗啡受体结合而产生与吗啡相似作用的化合物。阿片类药物可以是合成的、半合成的或天然的，并且能够轻易地与阿片受体结合以发挥其作用，其作用可能因药物暴露情况及其剂量的不同而有所变化。然而，也可以观察到阿片类药物的几种副作用，其中最关键的是它们对心脏电活动的影响。本综述主要关注阿片类药物对QT间期延长的影响及其致心律失常易感性。通过使用关键词，在各种数据库中检索了截至2022年发表的文章。检索词包括“心律失常”“QT间期”“阿片类药物”“阿片类药物依赖”和“尖端扭转型室性心动过速（TdP）”。这些术语突出了每种阿片类药物对心电图上心脏活动的影响。现有数据的结果表明，美沙酮等阿片类药物即使小剂量服用也具有较高风险，并且有导致QT间期延长和发生TdP的可能性。多种阿片类药物，如羟考酮和曲马多，被视为中等风险药物，大剂量使用时可导致QT间期延长和TdP。其他几种阿片类药物被视为低风险药物，包括丁丙诺啡和吗啡，日常常规剂量使用时不会导致TdP和QT间期延长。有证据表明，吸食鸦片者发生窦性心动过缓、心房颤动、心脏传导阻滞和室上性心律失常的风险较高。这篇文献综述将在确定阿片类药物使用与心律失常之间的关联方面发挥关键作用。它将进一步突出阿片类药物基于其剂量、频率和强度在心脏问题管理中的实际意义。此外，它还将描述阿片类药物的不良反应及其与剂量的特定关系。阿片类药物表现出不同的致心律失常性，美沙酮在常规剂量下诱导QT间期延长和危险心律失常的能力更强。为了降低致心律失常风险，对于高风险使用者，即接受阿片类药物维持治疗的患者，大量服用阿片类药物时应定期进行心电图监测。
