The electrocardiogram as a tool for therapeutic monitoring: a critical analysis

The authors review the scientific value of electrocardiographic studies and discuss the limitations that arise from variability in technology and in standards of recording and interpretation. A consistent recording procedure and objective assessment using standardized diagnostic criteria are required, particularly in multicenter studies. Tricyclic antidepressants depress cardiac conduction at therapeutic concentrations; therefore a comparison with the electrocardiographic profile of sertraline, a specific serotonin reuptake inhibitor with antidepressant activity, was made. In four studies, sertraline was compared with placebo, with amitriptyline or placebo, and with amitriptyline alone. There were decreases in RR interval and increases in PR, QRS, and QTC intervals with amitriptyline but no effect with sertraline. Thus, sertraline had no demonstrable effects on intraventricular conduction or electrocardiographic time intervals.