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Children with long QT syndrome treated for ADHD at increased cardiac risk
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According to a recent study, pediatric patients with long QT syndrome who also were treated with attention-deficit/hyperactivity disorder medications were at an increased risk for cardiac events.
“The results of this study indicate that there is a time-dependent increased risk for cardiac events, primarily syncope, in the long QT syndrome study population during ADHD pharmacotherapy, and particularly in male patients,” Claire Zhang, MD, of the University of Rochester Medical Center, and colleagues wrote. “ADHD medications should be prescribed for long QT syndrome patients only when dysfunctional symptoms clearly require therapy.”
The researchers analyzed data from a long QT syndrome (LQTS) registry gathered between 1979 and 2003. Forty-eight long QT syndrome patients also treated with ADHD medication were identified and matched for comparison with a control group of LQTS patients not exposed to ADHD medications (n = 96).
During 15 years of follow-up, patients in the ADHD medication group had a 62% likelihood of experiencing cardiac events vs. a 28% likelihood for patients in the control group (P < .001). These results remained similar across all three types of LQTS.
The researchers also found that time-dependent use of ADHD medications, both stimulant and nonstimulant, increased the risk for cardiac events (HR = 3.07; 95% CI, 1.09-8.64). Specifically, male LQTS patients were six times more likely to experience cardiac events while using time-dependent ADHD medications (HR = 6.8; 95% CI, 1.13-40.91) compared with controls. The researchers said this increase was not observed in female LQTS patients.
Adverse cardiac events associated with ADHD use in LQTS patients included syncope, tachycardia and palpitations. The researchers said heightened surveillance of patients who take ADHD medication and have LQTS is warranted.
“LQTS patients who require ADHD medication should receive the lowest effective dose and undergo close follow-up,” Zhang and colleagues wrote. – by David Costill
Disclosure: The researchers report no relevant financial disclosures.
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