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Heart Rhythm. 2013 Apr;10(4):526-30. doi: 10.1016/j.hrthm.2012.12.002. Epub 2012 Dec 6.

Antipsychotic drugs are associated with pulseless electrical activity: the Oregon Sudden Unexpected Death Study.

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  • 1Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.

Abstract

BACKGROUND:

There has been a paradigm shift in the manifestation of sudden cardiac arrest (SCA), with steadily decreasing rates of ventricular fibrillation/tachycardia (VF/VT) and a significant increase in the proportion of pulseless electrical activity (PEA) and asystole.

OBJECTIVE:

Since PEA is marked by failure of myocardial contractility, we evaluated the potential role of drugs that affect cardiac contractility in the pathophysiology of human PEA.

METHODS:

Subjects with out-of-hospital SCA (aged≥18 years) who underwent attempted resuscitation were evaluated in the ongoing Oregon Sudden Unexpected Death Study (2002-2009). Specific classes of medications with either negative or positive cardiac inotropic effects were evaluated for association with occurrence of PEA vs VF/VT by using Pearson χ(2) tests and logistic regression.

RESULTS:

PEA cases (n = 309) were older than VF/VT cases (n = 509; 68±14 years vs 64±15 years; P<.0001) and were more likely to be women (39% vs 25%; P<.0001). In a logistic regression model adjusting for age, sex, comorbidities, disease burden, and resuscitation variables, antipsychotic drugs (odds ratio 2.40; 95% confidence interval 1.26-4.53) were significant predictors of PEA vs VF/VT. Conversely, use of digoxin was associated with the occurrence of VF/VT (P<.0001).

CONCLUSIONS:

When drugs modifying myocardial contractility were evaluated in a comprehensive analysis of patients who suffered SCA, use of antipsychotic agents was a significant and independent predictor of manifestation with PEA.

Copyright © 2013 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

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PMID:
23220685
[PubMed - indexed for MEDLINE]
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