96-75: Prevalence and clinical outcome of atrial fibrillation in patients with pre-capillary and combined post- and pre-capillary pulmonary hypertension

Abstract

Introduction: Retrospective studies showed that Haloperidol results in higher incidence of sudden cardiac death and causes QTc prolongation and polymorphic ventricular arrhythmia at high dosage. We performed a prospective observational study in a general teaching hospital evaluating the effects of low-dose haloperidol on QTc-duration in frail admitted elderly patients with delirium. Methods: Inclusion criteria were: age !75y, ECG was made during admission and haloperidol was initiated within 1w. After at least two doses of haloperidol, a second ECG was made. Patients were grouped according to baseline QTc; normal QTc (nQT, male ,430ms, female ,450ms), borderline QTc (bQT, male 431-450ms, female 451-470ms) and abnormal QTc (aQT, male .450ms, female .470ms). Potentially dangerous QTc was defined as an increase in QTc by .50 ms or to a QTc of .500 ms. Results: We included 140 patients (46% male, mean age 85y, nQT n ¼ 93, bQT n ¼ 27, aQT n ¼ 20) who used on average 1.5 mg Haloperidol per 24h (comparable among groups). No patients developed potentially dangerous QTc. On average, patients with normal QTc at baseline experienced no change in QTc (nQT: þ4 + 21 ms) while patients with prolonged QTc showed a decrease (bQT: -16 + 28 ms, aQT: -20 + 27 ms, both p , 0.001 compared to nQT). 17 patients in nQT (18%) developed borderline or abnormal QTc while 24 patients in bQT or aQT (51%) developed a normal QTc after haloperidol use. Conclusion: Low-dose haloperidol appears safe. We did not see potentially dangerous QTc. On average, QTc shortening was seen in patients with borderline and abnormal QTc.