Sudden Cardiac Death in Schizophrenia: A Review

In patients with schizophrenia, cardiovascular disease accounts for nearly 50% of deaths and decreased life expectancy, and the incidence of sudden cardiac death is about four times higher than in the background population. While the majority of sudden deaths are due to ischaemic heart disease and its recognised risk factors, about 10% of sudden deaths are unexplained and are thought to be due to cardiac arrhythmias. This review discusses various factors that might contribute to this increased mortality, such as the effect of antipsychotic drugs on potassium and sodium channel function, increased incidence of Brugada pattern in patients with schizophrenia and the role of the autonomic nervous system. It stresses the control of traditional coronary risk factors and discusses various noninvasive tests to identify patients at risk. It also mentions the reported association for nonsynonymous genetic polymorphism rs10503929 within the neuregulin 1 gene (NRG1) and the minor allele C and its role in the risk of sudden cardiac death in schizophrenia.