Antipsychotic-induced sudden cardiac death: examination of an atypical reaction

Abstract

Following the publication of a recent study, which linked antipsychotics to sudden cardiac death, the safety of both typical and atypical antipsychotics has once again been questioned. Sudden cardiac death resulting from ventricular arrhythmias remains a significant public health concern, with over 300,000 deaths per year in the US alone. Long QT syndrome (LQTS) is an important cause of sudden cardiac death in which both congenital and acquired lesions in cardiac ionic channels impair myocardial repolarization and predispose the heart to developing lethal ventricular rhythms, including torsade de pointes, which may degenerate into ventricular fibrillation. Congenital LQTS is a relatively rare condition; however, acquired LQTS and arrhythmogenesis occurring through the unwanted pharmacological effects of a wide range of medications has become one of the largest problems facing the pharmaceutical industry today. This article examines recent findings linking antipsychotics to ventricular arrhythmias and explores potential new strategies to reduce the incidence of drug-induced sudden cardiac death.

Keywords::

• antipsychotic
• cardiotoxicity
• drug-induced arrhythmia
• sudden cardiac death
• torsade de pointes

Acknowledgments

The author acknowledges support from the Physiological Laboratory at the University of Cambridge in addition to research fellowships from Harvard Medical School and the Cardiovascular Research Centre at Massachusetts General Hospital.