Impaired heart rate variability and altered cardiac sympathovagal balance after antidepressant overdose

Waring, W. Stephen; Rhee, Jyoo-Hi; Bateman, D. Nicholas; Leggett, Gillian; Jamie, Helen

doi:10.1007/s00228-008-0505-7

Cited by 15 publications

(11 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Regarding TCA intoxication, antidepressant drugs are among the most common means of attempting suicide, and they are a serious risk factor for arrhythmias. Numerous studies have been performed to determine the development, type, and the severity of arrhythmia, and no standard indicator has yet been found [20]. It has been shown that HRV is markedly suppressed after imipramine and amitriptyline intake, and even if the EGC is normal, there is an association between the development of ventricular arrhythmia and increased LF/HF ratios [21].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, a meta-analysis showed that the therapeutic use of TCAs caused a considerable decrease in HRV [19]. There have been analyses showing HRV changes due to TCA-related poisoning in adults, and differences in HRV have been suggested to be predictors for ventricular arrhythmias in an adult patient [20, 21]. TCAs can be ingested accidentally or voluntarily by children or therapeutic mistakes can occur.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Heart Rate Variability in Children with Tricyclic Antidepressant Intoxication

Dinleyici

Kılıç

Şahin

et al. 2013

Cardiology Research and Practice

View full text Add to dashboard Cite

The aim of this study was to evaluate HRV in children requiring intensive care unit stays due to TCA poisoning between March 2009 and July 2010. In the time-domain nonspectral evaluation, the SDNN (P < 0.001), SDNNi (P < 0.05), RMSDD (P < 0.01), and pNN50 (P < 0.01) were found to be significantly lower in the TCA intoxication group. The spectral analysis of the data recorded during the first 5 minutes after intensive care unit admission showed that the values of the nLF (P < 0.05) and the LF/HF ratio (P = 0.001) were significantly higher in the TCA intoxication group, while the nHF (P = 0.001) values were significantly lower. The frequency-domain spectral analysis of the data recorded during the last 5 minutes showed a lower nHF (P = 0.001) in the TCA intoxication group than in the controls, and the LF/HF ratio was significantly higher (P < 0.05) in the intoxication group. The LF/HF ratio was higher in the seven children with seizures (P < 0.001). These findings provided us with a starting point for the value of HRV analysis in determining the risk of arrhythmia and convulsion in TCA poisoning patients. HRV can be used as a noninvasive testing method in determining the treatment and prognosis of TCA poisoning patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Heart Rate Variability in Children with Tricyclic Antidepressant Intoxication

Dinleyici

Kılıç

Şahin

et al. 2013

Cardiology Research and Practice

View full text Add to dashboard Cite

show abstract

“…Tricyclic antidepressants are capable of blocking alpha-adrenergic receptors, and this may lower systemic vascular resistance and result in hypotension, or orthostatic hypotension 35. High tricyclic doses increase sympathetic and decrease parasympathetic influence on heart rate variability 36. Tricyclic antidepressants also inhibit sodium channel conductance, so that phase 0 cardiac depolarization is delayed 37.…”

Section: Pharmacological Mechanisms Responsible For Cardiovascular Efmentioning

confidence: 99%

Clinical use of antidepressant therapy and associated cardiovascular risk

Waring¹

2012

DHPS

View full text Add to dashboard Cite

A number of different psychotropic agents have been associated with an increased risk of cardiovascular disease, and these relationships have been difficult to interpret due to the presence of confounding factors. Recently, there has been renewed interest in the potential for certain antidepressants to cause QT prolongation, which is a predisposing factor for arrhythmia. However, the optimum means of determining QT remains contentious due to discrepancies between methods that may be readily applied in a clinical setting versus more detailed techniques during regulatory assessment. A number of different pharmacological mechanisms might explain the occurrence of adverse cardiac effects, and these differ according to the type of antidepressant agent. Emerging data indicate that citalopram exhibits a dose-effect relationship for QT prolongation. Whereas cardiotoxicity is readily apparent in the context of intentional antidepressant overdose, the occurrence of cardiac effects as a result of therapeutic administration is less certain. Pre-existing cardiac disease and other factors that independently predispose to arrhythmia are important considerations. Therefore, clinical judgment is needed to evaluate the overall risk or benefit of a particular antidepressant in any patient. Close monitoring should be considered for those at greatest risk of QT prolongation and arrhythmia.

show abstract

“…(1-4) However, little research has examined the association between HRV and acute poisoning, except for antidepressant overdoses. (5,6) Many parameters used to quantify HRV have been introduced and are categorized into time domain, frequency domain, and nonlinear parameters. Table 1 summarizes HRV parameters with a brief description of each.…”

Section: Introductionmentioning

confidence: 99%

Heart rate variability analysis in acute poisoning by cholinesterase inhibitors

2017

View full text Add to dashboard Cite

Heart rate variability (HRV) has been associated with a variety of clinical situations. However, few studies have examined the association between HRV and acute poisoning. Organophosphate (OP) and carbamate inhibit esterase enzymes, particularly acetylcholinesterase, resulting in an accumulation of acetylcholine and thereby promoting excessive activation of corresponding receptors. Because diagnosis and treatment of OP and carbamate poisoning greatly depend on the severity of cholinergic symptoms, and because HRV reflects autonomic status, some HRV parameters may be of value in diagnosing OP and carbamate poisoning among patients visiting the emergency department. Patients who visited the emergency department of the study hospital between September 2008 and May 2010 with the chief complaint of acute poisoning or overdose were included. Cases that involved ingestion of OP or carbamate insecticides were classified as poisoning by cholinesterase inhibitors and compared with other cases of poisoning or overdose. The timedomain analysis included descriptive statistics of R-R intervals and instantaneous heart rates. The frequency-domain analysis used fast Fourier transformation. A Poincaré plot, which is a scatterplot of R-R intervals against the preceding R-R interval, was used for the nonlinear analysis. Very-low-frequency (VLF) power and the ratio of low-frequency-to-high-frequency power (LF/HF) were the most effective parameters for distinguishing cholinesterase inhibitor poisoning among cases of acute poisoning, with areas under the receiveroperating characteristic curve of 0.76 and 0.87, respectively. Cholinesterase inhibitor poisoning was a significant factor determining VLF power and the LF/HF ratio after adjusting for possible confounding variables, including age over 40, gender, and tracheal intubation. Frequency-domain parameters of HRV, such as VLF power and the LF/HF ratio, might be considered as potential diagnostic methods to distinguish cholinesterase inhibitor poisoning from other cases of intoxication in the early stages of emergency care.

show abstract

Impaired heart rate variability and altered cardiac sympathovagal balance after antidepressant overdose

Cited by 15 publications

References 33 publications

Heart Rate Variability in Children with Tricyclic Antidepressant Intoxication

Heart Rate Variability in Children with Tricyclic Antidepressant Intoxication

Clinical use of antidepressant therapy and associated cardiovascular risk

Heart rate variability analysis in acute poisoning by cholinesterase inhibitors

Contact Info

Product

Resources

About