Article Data

  • Views 4125
  • Dowloads 222

Original Research

Open Access

The New Markers of Ventricular Dispersion in Patients with Acute Poisoning with TCAs: Tp-e Interval and Tp-e/QTc Ratio

  • Akkan Avci1
  • Mehmet Uzucek1
  • Satuk BugraYapici1
  • Begum Seyda Avci2
  • Onder Yesiloglu1
  • Hayri Cinar1
  • Ferhat Icme3
  • Salim Satar1

1Department of Emergency Medicine, Adana City Research and Training Hospital, Health Science University, Adana, Turkey

2Department of Internal Medicine, Adana City Research and Training Hospital, Health Science University, Adana, Turkey

3Department of Emergency Medicine, Ankara City Hospital, Ankara, Turkey

DOI: 10.22514/sv.2020.16.0044 Vol.17,Issue 1,January 2021 pp.124-127

Published: 08 January 2021

*Corresponding Author(s): Akkan Avci E-mail: drakkanavci@gmail.com

Abstract

Introduction: Purpose of this study was to investigate the changes in Tp-e/QTc rates and Tp-e intervals in patients poisoned with tricyclic antidepressants. Methods: 187 patients who were poisoned with tricyclic antidepressants and admitted to our emergency department were included in this study. Control group consisted of 187 healthy individuals with similar age and gender characteristics. All patients underwent 12-lead electrocardiograms (ECG). In addition to QTc measurement, Tp-e/QTc ratios and Tp-e interval were measured in the ECG. Study data were divided two groups as patients and healthy controls. Results: It was found that the QTc interval, Tp-e interval, and Tp-e/QTc ratio were significantly higher in the patient group compared to control group. The analysis demonstrated that QTc interval; Tp-e interval and Tp-e/QTc ratio were independently associated with heart rate. Conclusion: In poisoning with TCAs, the rate of QTc interval, Tp-e/QTc and Tp-e interval has increased and is independently associated with the heart rate in these patients. This may be the precursor of possible fatal ventricular arrhythmias in tricyclic antidepressants.

Keywords

Tricyclic antidepressants, QTc interval, Tp-e/QTc ratio Tp-e interval, Emergency medicine

Cite and Share

Akkan Avci,Mehmet Uzucek,Satuk BugraYapici,Begum Seyda Avci,Onder Yesiloglu,Hayri Cinar,Ferhat Icme,Salim Satar. The New Markers of Ventricular Dispersion in Patients with Acute Poisoning with TCAs: Tp-e Interval and Tp-e/QTc Ratio. Signa Vitae. 2021. 17(1);124-127.

References

[1] Sık G, Nisli K, Çıtak A. Serious Cardiac Arrhythmia in Amitriptyline Poisoning: Case Report. Pediatr Emerg Intens Care Med. 2014;1:39-42.

[2] Otal Y, Karatas AD, Baydın A, et al. Ölümcül Doz Amitriptilin Zehirlenmesi: Olgu Sunumu. Fırat Tıp Dergisi 2009;14:160-162.

[3] Kongstad O, Xia Y, Liang Y, et al. Epicardial and endocardial dispersion of ventricular repolarization. A study of monophasic action potential mapping in healthy pigs. Scand Cardiovasc J. 2005;39:342-347.

[4] Porthan K, Viitasalo M, Toivonen L, et al. Predictive Value of Electrocar-diographic T Wave Morphology Parameters and T-Wave Peak to T-Wave End Interval for Sudden Cardiac Death in the General Population Clinical Perspective. Circ Arrhythm Electrophysiol. 2013;6:690-696.

[5] Chua KC, Rusinaru C, Reinier K, et al. Tpeak-to-Tend interval corrected for heart rate: A more precise measure of increased sudden death risk?Heart rhythm. 2016;13:2181-2185.

[6] Xia Y, Liang Y, Kongstad O, et al. Tpeak-Tend interval as an index of global dispersion of ventricular repolarization: evaluations using monophasic action potential mapping of the epi- and endocardium in swine. J Interv Card Electrophysiol. 2005;14:79–87.

[7] Gupta P, Patel C, Patel H, et al. T(p-e)/QT ratio as an index of arrhythmogenesis. J Electrocardiol. 2008;41:567–74.

[8] Erikssen G, Liestol K, Gullestad L, et al. The terminal part of the QT interval (T peak to T end): a predictor of mortality after acute myocardial infarction. Ann Noninvasive Electrocardiol. 2012;17:85-94.

[9] Smetana P, Schmidt A, Zabel M, et al. Assessment of repolarization heterogeneity for prediction of mortality in cardiovascular disease: peak to the end of the T wave interval and nondipolar repolarization components. J Electrocardiol. 2011;44:301-308.

[10] Acikalin A, Gulen M, Acehan S, et al. All Supraventricular Tachycardia are not Cardiogenic: Case Report. JAEMCR. 2011;2:39-42.

[11] Pentel P, Benowitz N. Tricyclic antidepressant poisoning: management of arrhythmias. Med Toxicol. 1986;1:101-121.

[12] Niemann JT, Bessen HA, Rothstein RJ, et al. Electrocardiographic criteria for tricyclic antidepressant cardiotoxicity. Am J Cardiol. 1986;57:1154–1159.

[13] Caravati EM, Bossart PJ. Demographic and electrocardiographic factors associated with severe tricyclic antidepressant toxicity. J Toxicol Clin Toxicol. 1991;29:31–43.

[14] Acikalin A, Satar S, Avci A, et al. QTc intervals in drug poisoning patients with tricyclic antidepressants and selective serotonin reuptake inhibitors. Am J Ther. 2010;17:30-33.

[15] Okayasu H, Ozeki Y, Fujii K, et al. Investigation of the Proarrhythmic Effects of Antidepressants according to QT Interval, QT Dispersion and T Wave Peak-to-End Interval in the Clinical Setting. Psychiatry Investig. 2019;16:159-166.

Submission Turnaround Time

Top