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Serial electrocardiogram changes in acute tricyclic antidepressant overdoses

E L Liebelt¹, A Ulrich, P D Francis

¹Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA.

Critical Care Medicine

|October 23, 1997

Summary

Tricyclic antidepressant poisoning can cause prolonged QRS intervals and abnormal T40-ms axes, which may persist despite clinical improvement. Patients with seizures or arrhythmias showed more severe and prolonged electrocardiogram (ECG) abnormalities.

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Area of Science:

Cardiology
Clinical Toxicology
Pharmacology

Background:

Tricyclic antidepressant (TCA) overdose is a significant cause of poisoning.
Electrocardiogram (ECG) abnormalities, including QRS widening and axis deviation, are common in TCA toxicity.
The temporal course and clinical significance of these ECG changes require further elucidation.

Purpose of the Study:

To characterize the evolution of QRS interval and T40-ms frontal axis over time in patients with acute TCA poisoning.
To identify clinical factors and treatments associated with ECG changes.
To compare ECG changes in patients with and without TCA-related complications (seizures, arrhythmias).

Main Methods:

Prospective, observational cohort study.
Inclusion of 36 patients with acute TCA ingestion and elevated TCA levels.

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Serial ECG recordings obtained within the first 8 hours and until discharge.

Main Results:

Maximal QRS interval and T40-ms axis abnormalities often occurred at presentation.
QRS interval normalized in 15 patients, with a median time of 20 hours.
T40-ms axis normalized in 6 patients, with a median time of 13 hours.
Patients with seizures and/or arrhythmias exhibited significantly more prolonged and severe ECG abnormalities.
No significant differences in clinical characteristics or treatment between groups.

Conclusions:

Conduction abnormalities in severe TCA toxicity have variable resolution times and can persist.
All ECG parameters were more abnormal in patients who developed seizures or arrhythmias.
Clinical improvement does not always correlate with rapid resolution of ECG abnormalities.