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October 11, 2021
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Implantable monitor detects arrhythmias in patients on psychotropic medications

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An implantable loop recorder feasibly and acceptably monitored arrythmias among patients taking psychotropic medication, according to results of a cohort study in a research letter published in JAMA Psychiatry.

“Psychotropic medication, especially antipsychotics, are suspected to contribute to premature death by potentially inducing arrhythmias," Julie Nordgaard, MD, PhD, DMsc, of the Mental Health Center Amager in Denmark,  told Healio Psychiatry. “With this new device, it has become possible to address the question of whether patients in treatment with psychotropic medication are prone to experience arrhythmias."

Alert on heart monitor
Source: Adobe Stock

Julie Nordgaard

In the current study, Nordgaard and Thomas Melchior, MD, PhD, of the department of cardiology at Zealand University Hospital Roskilde in Denmark, aimed to determine the feasibility of arrhythmia monitoring via an ILR, as well arrhythmia incidence among 20 patients (11 women; median age, 37 years) with mental disorders who received psychotropic drugs for 6 months or longer and had no heart disease history. Patients received the IRL, which is a small, battery-powered monitor implanted under the skin of the chest, under local anesthesia at an outpatient clinic. During patients’ daily living, the IRL can detect and transmit the presence of predefined arrhythmias. Patients received one or more psychotropic medications, with 19 receiving antipsychotics, six antidepressants, two valproate and seven benzodiazepines. The researchers reported concomitant substance use among six patients. All patients presented with sinus rhythm without bundle branch block. They had normal echocardiographic findings at study entry and termination.

Nineteen patients completed the 2-year ILR monitoring; one underwent premature ILR removal due to persistent skin itching. Results showed pathological arrhythmias among four (21%) patients. Nordgaard and Melchior reported one case of nonsustained ventricular tachycardia and two cases of presumably atrioventricular-nodal reentry tachycardia. Two patients had their medications changed during the study period because of arrythmia or corrected QT interval prolongation.

“If our findings are replicated in larger studies, they will have clinical implications, such as making more restrictive use of such medication, minimization of off-label use and major cardiac examinations necessary for at least some of the patients,” Nordgaard said.