Ruey-Hsing Chou1, Li-Wei Lo2, Ying-Jay Liou3, Jiah-Hwang Shu4, Hsiu-Chuan Hsu4, Ying Liang4, Chin-Chou Huang5, Po-Hsun Huang1, Shing-Jong Lin6, Jaw-Wen Chen7, Wan-Leong Chan8, Hsin-Bang Leu9. 1. Division of Cardiology, Department of Medicine, Taipei, Taiwan; Cardiovascular Research Center, Taipei, Taiwan; Institute of Clinical Medicine, Taipei, Taiwan. 2. Division of Cardiology, Department of Medicine, Taipei, Taiwan; Institute of Clinical Medicine, Taipei, Taiwan. 3. Department of Psychiatry, Taipei, Taiwan; Division of Psychiatry, School of Medicine, Taipei, Taiwan. 4. Department of Nursing, Taipei, Taiwan. 5. Department of Medical Research and Education, Taipei, Taiwan; Cardiovascular Research Center, Taipei, Taiwan. 6. Division of Cardiology, Department of Medicine, Taipei, Taiwan; Department of Medical Research and Education, Taipei, Taiwan; Cardiovascular Research Center, Taipei, Taiwan; Institute of Clinical Medicine, Taipei, Taiwan. 7. Division of Cardiology, Department of Medicine, Taipei, Taiwan; Department of Medical Research and Education, Taipei, Taiwan; Cardiovascular Research Center, Taipei, Taiwan; Institute of Pharmacology National Yang-Ming University, Taipei, Taiwan. 8. Division of Cardiology, Department of Medicine, Taipei, Taiwan; Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan. 9. Division of Cardiology, Department of Medicine, Taipei, Taiwan; Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Research Center, Taipei, Taiwan; Institute of Clinical Medicine, Taipei, Taiwan. Electronic address: hbleu@vghtpe.gov.tw.
Abstract
BACKGROUND: Antipsychotic agents are well known for their arrhythmigenic effect on ventricular arrhythmia. Though a few case reports observed the occurrence of atrial fibrillation (AF) after antipsychotic exposure, information about their implication in AF is limited. METHODS: Based on the National Health Insurance Database in Taiwan, we conducted a nested case-control study to investigate the relationship between antipsychotics and AF. From 2001 to 2010, a total of 34,053 cases of AF and 34,919 matched controls were enrolled. Antipsychotic exposure was measured and binding affinity to neurotransmitter receptors was calculated. Both medical and psychiatric comorbidities were identified and adjusted in multivariate logistic regression analysis. RESULTS: Current antipsychotic use was associated with a 17% increased risk of AF relative to nonusers (adjusted OR: 1.17, 95% CI: 1.10-1.26). A dose-dependent relationship of antipsychotic exposure and AF risk was observed (P for trend <0.001). Antipsychotics with higher binding affinity to muscarinic M2 receptors were associated with a higher incidence of AF. In subgroup analysis, subjects with preexisting hypertension, diabetes, or coronary artery diseases were at greater risk of developing AF following antipsychotic exposure. CONCLUSION: Antipsychotic exposure was associated with increased risk of AF, especially for agents with higher cardiac muscarinic receptor binding affinity. Physicians should monitor the occurrence of new-onset AF, and strictly control underlying medical risk factors while prescribing antipsychotic agents to high-risk populations.
BACKGROUND: Antipsychotic agents are well known for their arrhythmigenic effect on ventricular arrhythmia. Though a few case reports observed the occurrence of atrial fibrillation (AF) after antipsychotic exposure, information about their implication in AF is limited. METHODS: Based on the National Health Insurance Database in Taiwan, we conducted a nested case-control study to investigate the relationship between antipsychotics and AF. From 2001 to 2010, a total of 34,053 cases of AF and 34,919 matched controls were enrolled. Antipsychotic exposure was measured and binding affinity to neurotransmitter receptors was calculated. Both medical and psychiatric comorbidities were identified and adjusted in multivariate logistic regression analysis. RESULTS: Current antipsychotic use was associated with a 17% increased risk of AF relative to nonusers (adjusted OR: 1.17, 95% CI: 1.10-1.26). A dose-dependent relationship of antipsychotic exposure and AF risk was observed (P for trend <0.001). Antipsychotics with higher binding affinity to muscarinic M2 receptors were associated with a higher incidence of AF. In subgroup analysis, subjects with preexisting hypertension, diabetes, or coronary artery diseases were at greater risk of developing AF following antipsychotic exposure. CONCLUSION: Antipsychotic exposure was associated with increased risk of AF, especially for agents with higher cardiac muscarinic receptor binding affinity. Physicians should monitor the occurrence of new-onset AF, and strictly control underlying medical risk factors while prescribing antipsychotic agents to high-risk populations.