Article date: December 2010
By: W. Stephen Waring, Ann Graham, Julie Gray, Allen D. Wilson, Catherine Howell, D. Nicholas Bateman, in Volume 70, Issue 6, pages 881-885
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT
AIMS
A QT‐heart rate nomogram has recently been proposed as a means of identifying patients at risk of torsades de pointes after antidepressant overdose, based on published cases of drug‐induced torsades de pointes. The present study sought to examine the performance of the nomogram in patients who ingest an antidepressant overdose but do not develop arrhythmia.
METHODS
A retrospective case control study of patients presenting to hospital after overdose of citalopram, mirtazapine and venlafaxine was carried out. The primary outcome variable was QT higher than the nomogram, and was compared with occurrence of QTc (QT corrected by Bazett's formula) greater than ≥440 ms and QTc≥500 ms, with comparison between drugs. Data are expressed as proportions in each group with 95% confidence intervals.
RESULTS
There were 858 electrocardiograms from 541 patients. QT was higher than the nomogram in 2.4% (1.4, 4.1%), whereas QTc was ≥440 ms in 23.1% (95% CI 19.8, 26.8%), and QTc was ≥500 ms in 1.1% (0.5, 2.5%). Citalopram overdose was more likely to be associated with QT higher than the nomogram compared with the other agents (difference 7.0%, 95% CI 2.9, 11.9%, P = 0.001) and more likely to be associated with QTc≥440 ms (difference = 11.0%, 95% CI 2.6, 19.0%, P = 0.013).
CONCLUSIONS
The QT nomogram was associated with a lower false positive rate than widely accepted QTc criteria, and allowed detection of different effects of individual drugs. The nomogram offers potential advantages over QTc criteria and merits further investigation in a clinical setting.
DOI: 10.1111/j.1365-2125.2010.03728.x
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