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Brugada syndrome ECG is highly prevalent in schizophrenia
Marieke T Blom1, Dan Cohen1, Adrie Seldenrijk1
1From the Heart Center (M.T.B., H.L.T.) and Department of Cardiology (H.L.T.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Community Mental Health, Mental Health Care North Holland North, Heerhugowaard, the Netherlands (D.C.); Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands (D.C.); Department of Epidemiology and Biostatistics (A.S., B.W.J.H.P., J.M.D.), Department of Psychiatry (A.S., B.W.J.H.P.), EMGO Institute for Health and Care Research (G.N., J.M.D.), and Department of General Practice (G.N.), VU University Medical Center, Amsterdam, the Netherlands; and Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, the Netherlands (C.D.A.S.).
Insights
Patients with schizophrenia have a higher prevalence of Brugada-ECG, a marker for sudden cardiac death risk. This increased risk is not linked to sodium channel-blocking medications.
Area of Science:
- Cardiology
- Psychiatry
- Pharmacology
Background:
- Schizophrenia is associated with an increased risk of sudden cardiac death, but the underlying causes remain unclear.
- Electrocardiogram (ECG) markers, particularly the Brugada-ECG pattern, are critical for assessing sudden cardiac death risk.
Purpose of the Study:
- To investigate the prevalence of Brugada-ECG and other ECG markers of sudden cardiac death risk in patients with schizophrenia.
- To determine if any observed increase in these markers is attributable to confounding factors, such as sodium channel-blocking medication.
Main Methods:
- A cross-sectional study analyzed ECGs and medication use in 275 schizophrenia patients.
- Comparisons were made with control groups: the Netherlands Study of Depression and Anxiety (NESDA) cohort (N=179) and the Hoorn cohort (n=1168).
- Multivariate regression models were employed to analyze ECG measures (heart rate, PQ-, QRS-, QT-intervals) and Brugada-ECG prevalence.
Main Results:
- Brugada-ECG was significantly more prevalent in schizophrenia patients (11.6%) compared to NESDA (1.1%) and Hoorn (2.4%) controls.
- Schizophrenia patients exhibited longer QT-intervals and a higher proportion of QTc prolongation.
- Elevated heart rates were also observed in the schizophrenia cohort compared to controls.
- The increased prevalence of Brugada-ECG persisted even when excluding patients on sodium channel-blocking medication (9.6%).
Conclusions:
- Brugada-ECG is more prevalent in patients with schizophrenia, indicating a potential link to sudden cardiac death risk.
- This association is independent of sodium channel-blocking medication use, suggesting other underlying mechanisms.
Background:
The causes of increased risk of sudden cardiac death in schizophrenia are not resolved. We aimed to establish (1) whether ECG markers of sudden cardiac death risk, in particular Brugada-ECG pattern, are more prevalent among patients with schizophrenia, and (2) whether increased prevalence of these ECG markers in schizophrenia is explained by confounding factors, notably sodium channel-blocking medication.
Methods And Results:
In a cross-sectional study, we analyzed ECGs of a cohort of 275 patients with schizophrenia, along with medication use. We determined whether Brugada-ECG was present and assessed standard ECG measures (heart rate, PQ-, QRS-, and QT-intervals). We compared the findings with nonschizophrenic individuals of comparable age (the Netherlands Study of Depression and Anxiety [NESDA] cohort; N=179) and, to account for assumed increased aging rate in schizophrenia, with individuals 20 years older (Hoorn cohort; n=1168), using multivariate regression models. Brugada-ECG was significantly more prevalent in the schizophrenia cohort (11.6%) compared with NESDA controls (1.1%) or Hoorn controls (2.4%). Moreover, patients with schizophrenia had longer QT-intervals (410.9 versus 393.1 and 401.9 ms; both P<0.05), increased proportion of mild or severe QTc prolongation (13.1% and 5.8% versus 3.4% and 0.0% [NESDA], versus 5.1 and 2.8% [Hoorn]), and higher heart rates (80.8 versus 61.7 and 68.0 beats per minute; both P<0.05). The prevalence of Brugada-ECG was still increased (9.6%) when patients with schizophrenia without sodium channel-blocking medication were compared with either of the control cohorts.
Conclusions:
Brugada-ECG has increased prevalence among patients with schizophrenia. This association is not explained by the use of sodium channel-blocking medication.
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