Lithium-induced electrocardiographic changes: A complete review

Lithium has been used for the treatment of bipolar disorder for more than 6 decades. Reports of cardiac side effects resulting in both benign electrocardiographic (ECG) changes and near fatal arrhythmias have been reported in the literature. A systematic literature search was conducted on 2 electronic databases-PubMed and Medline-for the time period between January 1970 and March 2016 using the key word "lithium," along with "electrocardiography" or "ECG." All articles and their references were then screened by title for relevance by 2 authors and a librarian. A total of 406 articles were found on literature search, of which 56 met the screening criteria. T wave inversion was the most frequently reported ECG finding. Other findings include sinus node dysfunction, sinoatrial blocks, PR prolongation, QT prolongation/dispersion, and ventricular tachyarrhythmias. Some cases have shown lithium-treated patients experiencing serious cardiac outcomes, such as ST elevation myocardial infarction, heart blocks, and the Brugada pattern. Electrical changes from lithium were found to be dependent on both duration of treatment and the serum lithium level. Although there are no standardized ECG guidelines, frequent monitoring of patients on lithium therapy can ensure the medication's safe use.