TY - JOUR
T1 - Antipsychotic drugs are associated with pulseless electrical activity
T2 - The Oregon Sudden Unexpected Death Study
AU - Teodorescu, Carmen
AU - Reinier, Kyndaron
AU - Uy-Evanado, Audrey
AU - Chugh, Harpriya
AU - Gunson, Karen
AU - Jui, Jonathan
AU - Chugh, Sumeet S.
N1 - Funding Information:
This work was supported in part by a postdoctoral award from the American Heart Association and Philips Healthcare to Dr Teodorescu. Dr Chugh is the Pauline and Harold Price Professor of Cardiac Electrophysiology at the Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
PY - 2013/4
Y1 - 2013/4
N2 - 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 χ2 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.
AB - 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 χ2 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.
KW - Antipsychotic drugs
KW - Beta-blockers
KW - Death, sudden cardiac
KW - Myocardial contractility
KW - Pulseless electrical activity
KW - Ventricular fibrillation
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U2 - 10.1016/j.hrthm.2012.12.002
DO - 10.1016/j.hrthm.2012.12.002
M3 - Article
C2 - 23220685
AN - SCOPUS:84875702776
SN - 1547-5271
VL - 10
SP - 526
EP - 530
JO - Heart Rhythm
JF - Heart Rhythm
IS - 4
ER -