Effect of long-term combined use of antipsychotics on ventricular repolarization index

Abstract

Objective Antipsychotics can prolong the time of ventricular repolarization. Multiple-drug interactions may increase the risk of developing cardiac arrhythmias. It is generally recommended to avoid the combination of drugs that prolong ventricular repolarization or drugs that interact with pharmacokinetics, but in the real world,the combination is inevitable. We retrospectively analyzed heart rate, QRS duration, QT, QTc, TpTe, TpTe, TpTe / QRS, TpTe / QT, TpTe / QTc in consecutive patients with schizophrenia, cardiac electrophysiological balance index (iCEB), iCEBc,and compared with QTc interval to evaluate more effective alternative indexes and to explore the safety of long-term combined use of antipsychotics. And the significance of arrhythmia induced or aggravated by the change of ventricular repolarization index. Methods Patients with schizophrenia who take drugs in combination. 12-lead synchronous ECG examination was collected every 2-4 weeks. The electrocardiogram with the most significant abnormal changes each year was used to measure the duration of the QRS wave and to measure and calculate a series of ventricular repolarization indexes. The types and times of arrhythmias were observed, the types and doses of drugs taken were recorded, and the hematological indexes were monitored and compared with those of the previous year. Results When the patients were treated with antipsychotics for 5 years, There was no significant difference in gender effect on RR interval. The duration of the QRS wave in males was longer than that in females. TpTe, TpTe/QRS TpTe/QT, TpTe/QTc, iCEB, and iCEBc increased significantly with the prolongation of hospital stay, while TpTe, TpTe/QRS, TpTe/QT, and TpTe/QTc more obvious changes in such indicators appeared in female patients( P < 0.01). The changes in iCEB and iCEBc were more significant in males ( P < 0.01). The incidence of arrhythmia within 5 years was 2.5%, 6.25%, 6.25%,6.25% and 5%, respectively. More than 90% of patients treated with antipsychotics did not have any arrhythmias. No TdP syncope, or other cardiovascular symptoms were found in all patients. Conclusion Long-term combined use of antipsychotics had no significant effect on ventricular depolarization (QRS duration). iCEB, iCEBc, TpTe, TpTe/QT, TpTe/QTc, and TpTe/QRS prolonged with increasing treatment time.Among them, the gender differences were significant for TpTe, TpTe / QTc, TpTe / QT, iCEB, and iCEBc. The arrhythmic rate was low within the observed 5 years, and the prolongation of the ventricular repolarization index did not significantly increase the incidence of arrhythmia.