Antipsychotic drugs and the risk of ventricular arrhythmia and/or sudden cardiac death: a nation-wide case-crossover study

Background: antipsychotics have been linked to prolongation of the qt interval. however,little is known about the risk of ventricular arrhythmia (va) and/or sudden cardiac death (scd) associated with individual antipsychotic drug use. this study was designed to investigate the association between specific antipsychotic drugs and the risk of va and/or scd.methods and results: we conducted a case-crossover study using a nation-wide population-based sample obtained from taiwan's national health insurance research database. a total of 17 718 patients with incident va and/or scd were enrolled. conditional logistic regression models were applied to examine the effects of antipsychotic drug use on the risk of va/scd during various case and control time windows of 7,14,and 28 days. the effect of the potency of a human ether-à-go-go-related gene (herg) potassium channel blockade was also assessed. antipsychotic drug use was associated with a 1.53-fold increased risk of va and/or scd. antipsychotic drugs with increased risk included clothiapine,haloperidol,prochlorperazine,thioridazine,olanzapine,quetiapine,risperidone,and sulpiride. the association was significantly higher among those with short-term use. antipsychotics with a high potency of the herg potassium channel blockade had the highest risk of va and/or scd.conclusion: use of antipsychotic drugs is associated with an increased risk of va and/or scd. careful evaluations of the risks and benefits of antipsychotic treatment are highly recommended. © 2015 the authors. published on behalf of the american heart association,inc.,by wiley blackwell.