Kursat Altinbas1, Sinan Guloksuz2, Ilker Murat Caglar3, Fatma Nihan Turhan Caglar4, Erhan Kurt5, Esat Timucin Oral6. 1. Canakkale Onsekiz Mart University Faculty of Medicine, Department of Psychiatry, Canakkale, Turkey. Electronic address: kursataltinbas@gmail.com. 2. Yale University, Department of Psychiatry, New Haven, CT, USA; Department of Psychiatry and Psychology, Maastricht University Medical Centre, EURON, Maastricht, The Netherlands. 3. Bakirkoy Sadi Konuk Research and Training Hospital, Department of Cardiology, Istanbul, Turkey. 4. Istanbul Research and Training Hospital, Department of Cardiology, Istanbul, Turkey. 5. Rasit Tahsin Mood Clinic, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey. 6. Istanbul University of Commerce, Department of Psychology, Istanbul,Turkey.
Abstract
OBJECTIVE: Cardiovascular side effects of lithium have been reported to occur mainly at higher-than-therapeutic serum levels. We aimed to investigate the impact of the long-term lithium use on electrocardiogram (ECG) parameters in association with the serum levels in patients with bipolar disorder (BD) and in healthy controls (HCs) serving as the reference group. METHODS: The study sample consisted of 53 euthymic BD type I patients on lithium monotherapy at therapeutic serum levels (M = 0.76, S.D. = 0.14, range = 0.41-1.09 mmol/l) for at least 12 months and 45 HCs. A 12-lead surface ECG was obtained from all participants at resting state for at least half an hour for 5-min recording. Heart-rate, Pmax, Pmin, QRS interval, QT dispersion, QT dispersion ratio (QTdR) and Tpeak-to-end interval (TpTe) were measured. RESULTS: Regression analyses revealed that QTdR (B = 14.17, P = .001), TpTe (B = 18.38, P < .001), Pmax (B = 17.84, P<.001) and Pmin (B = 25.10, P < .001) were increased in BD patients who were on chronic lithium treatment than in HCs after controlling for age, sex and strict Bonferroni correction for multiple testing. There were no associations between serum lithium levels and ECG parameters. CONCLUSION: Our findings suggest that the use of lithium is associated with both atrial and ventricular electrical instability, even when lithium levels are in the therapeutic range.
OBJECTIVE: Cardiovascular side effects of lithium have been reported to occur mainly at higher-than-therapeutic serum levels. We aimed to investigate the impact of the long-term lithium use on electrocardiogram (ECG) parameters in association with the serum levels in patients with bipolar disorder (BD) and in healthy controls (HCs) serving as the reference group. METHODS: The study sample consisted of 53 euthymic BD type I patients on lithium monotherapy at therapeutic serum levels (M = 0.76, S.D. = 0.14, range = 0.41-1.09 mmol/l) for at least 12 months and 45 HCs. A 12-lead surface ECG was obtained from all participants at resting state for at least half an hour for 5-min recording. Heart-rate, Pmax, Pmin, QRS interval, QT dispersion, QT dispersion ratio (QTdR) and Tpeak-to-end interval (TpTe) were measured. RESULTS: Regression analyses revealed that QTdR (B = 14.17, P = .001), TpTe (B = 18.38, P < .001), Pmax (B = 17.84, P<.001) and Pmin (B = 25.10, P < .001) were increased in BD patients who were on chronic lithium treatment than in HCs after controlling for age, sex and strict Bonferroni correction for multiple testing. There were no associations between serum lithium levels and ECG parameters. CONCLUSION: Our findings suggest that the use of lithium is associated with both atrial and ventricular electrical instability, even when lithium levels are in the therapeutic range.
Authors: Andrea Murru; Dina Popovic; Isabella Pacchiarotti; Diego Hidalgo; Jordi León-Caballero; Eduard Vieta Journal: Curr Psychiatry Rep Date: 2015-08 Impact factor: 5.285