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

作者：Teodorescu Carmen; Reinier Kyndaron; Uy Evanado Audrey; Chugh Harpriya; Gunson Karen; Jui Jonathan; Chugh Sumeet S^*

来源：Heart Rhythm, 2013, 10(4): 526-530.

DOI：10.1016/j.hrthm.2012.12.002

• Death, sudden cardiac
• Pulseless electrical activity
• Ventricular fibrillation
• Antipsychotic drugs
• Beta-blockers
• Myocardial contractility

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. %26lt;br%26gt;OBJECTIVE Since PEA is marked by failure of myocardial contractility, we evaluated the potential rote of drugs that affect cardiac contractility in the pathophysiology of human PEA. %26lt;br%26gt;METHODS Subjects with out-of-hospital SCA (aged %26gt;= 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 chi(2) tests and Logistic regression. %26lt;br%26gt;RESULTS PEA cases (n = 309) were order than VF/VT cases (n = 509; 68 +/- 14 years vs 64 +/- 15 years; P %26lt; .0001) and were more likely to be women (39% vs 25%; P %26lt; .0001). In a Logistic regression mode L 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 %26lt; .0001). %26lt;br%26gt;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.

• 出版日期2013-4