Effect of Antipsychotic Medications on ECG Parameters in Psychiatric Patients: A Cross-sectional Study

Introduction: Antipsychotic drugs are associated with Electrocardiogram (ECG) changes at therapeutic doses, although these changes are generally benign. Several psychotropic drugs have been linked to sudden death due to their prolongation of the corrected QT (QTc) interval, which can lead to polymorphic ventricular arrhythmia. Aim: To study the ECG changes induced by antipsychotic medications and potential Drug-Drug Interactions (DDIs) contributing to these changes in psychiatric patients. Materials and Methods: A cross-sectional study was conducted by the Department of Pharmacology in the Outpatient Department (OPD) of Psychiatry at Maharaja Krishna Chandra Gajapati (MKCG) Medical College and Hospital, Berhampur, Odisha, India, from December 2022 to November 2023. ECGs were obtained using a 12-lead portable ECG device (Spandan) in each case. Potential DDIs that may cause QTc prolongation were assessed using the Lexicomp® tool. Results: A total of 205 psychiatric patients were included in the present study, of which 142 (69%) were males and 31% (n=63) were females, with a mean age of 42.4±14.64 years. A total of 82 patients (40%) exhibited some ECG abnormalities. Among these abnormalities, 40% displayed abnormal ST/T changes, followed by 36% with QTc prolongation, and 16% with abnormal heart rates. Among the antipsychotics, haloperidol (p=0.037) showed a significant association with QTc changes. Female sex (p=0.027) was identified as a significant risk factor associated with QTc changes. The drug combinations with the highest potential for causing QTc changes were Olanzapine+Escitalopram (25%), followed by Haloperidol+Olanzapine (16%) The association of drugs with ECG changes and risk factor associations were analysed using the Chi-square test and odds ratio. Conclusion: The use of psychotropic drugs may be associated with ECG changes at usual doses. Therefore, psychiatric patients should be evaluated for ECG abnormalities prior to the initiation of antipsychotic medications to avoid potential cardiovascular complications. Regular medication reviews are also necessary to identify and prevent potential drug-drug interactions.