Assessing prolongation of the heart rate corrected QT interval in users of tricyclic antidepressants
Journal of Clinical Psychopharmacology , Volume 35 - Issue 3 p. 260- 265
A prolonged heart rate corrected QT interval (QTc) increases the risk of sudden cardiac death. Some methods of heart rate correction (notably Bazett) overestimate QTc in people with high heart rates. Studies suggest that tricyclic antidepressants (TCAs) can prolong the QTc and increase heart rate. Therefore, we aimed to study whether TCA-induced QTc prolongation is a false-positive observation due to overestimation at high heart rates. For this, we included 12,734 participants from the prospective population-based Rotterdam Study, with a total of 27,068 electrocardiograms (ECGs), of which, 331 during TCA use. Associations between use of TCAs,QTc, and heart ratewere studiedwith linear repeated measurement analyses. QTwas corrected for heart rate according to Bazett (QTc<inf>Bazett</inf>), Fridericia (QTc<inf>Fridericia</inf>), or a correction based on regression coefficients obtained from the Rotterdam Study data (QTcStatistical). On ECGs recorded during TCA use,QTc<inf>Bazett</inf> was 6.5 milliseconds (95%confidence interval, 4.0-9.0) longer, and heart ratewas 5.8 beats per minute (95% confidence interval, 4.7-6.9) faster than during nonuse. QTcFridericia and QTc<inf>Statistical</inf> were not statistically significantly longer during TCA use than during nonuse. Furthermore, QTc<inf>Bazett</inf> was similar for ECGs recorded during TCA use and nonuse after statistical adjustment for heart rate. According to our results, TCA use does not seem to be associated with QTc prolongation. Therefore, the current advice of regulatory authorities to restrict the use of these drugs and to do regular checkups of the QTc may need to be revised. Other formulas, like Fridericia's, might be preferred.
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Noordam, R, van den Berg, M.E, Niemeijer, M.N, Aarts, N, Leening, M.J.G, Deckers, J.W, … Visser, L.E. (2015). Assessing prolongation of the heart rate corrected QT interval in users of tricyclic antidepressants. Journal of Clinical Psychopharmacology, 35(3), 260–265. doi:10.1097/JCP.0000000000000321