Şizofreni Hastalarında Brugada EKG Paterni ve Fragmente QRS İlişkisi

Abstract

Amaç: Şizofreni, ölümcül ritim bozuklukları ve ani kardiyak ölüm riski yüksek olan psikiyatrik bir hastalıktır. Brugada sendromunun şizofreni hastalarında oldukça yaygın olduğunu düşünülmektedir. Bu çalışmada şizofreni hastalarında Brugada sendromu ve fraqmanted QRS prevelansını araştırmayı amaçladık. Yöntemler: Psikiyatri kliniğinde izlenen iki yüz elli şizofreni hastası ve 400 yaş ve cinsiyet uyumlu şizofreni olmayan kontrol grubu çalışmaya dahil edildi. Standart EKG'ler ve iki interkostal aralığın üzerinde V1 ve V2 derivasyonu olan yüksek interkostal EKG'ler alındı. Bulgular: Şizofreni hastalarında Tip 1 Brugada sendromu gözlenmedi, bir hastada Tip 2 Brugada, iki hastada Tip 3 Brugada gözlendi. Kontrol grubunda bir hastada Tip 2 Brugada paterni belirlendi ve yine bir kontrol hastasında Tip 3 Brugada paterni vardı (p = 0.320). Fragmented QRS (fQRS) insidansı, QRS süresi ve düzeltilmiş QT'nin şizofreni grubunda kontrol grubuna göre daha yüksek olduğu gözlendi (sırasıyla p = 0.001, p = 0.003, p <0.001). Sonuç: Şizofreni hastalarında Brugada EKG paterninin prevalansında artış yoktur. Şizofreni hastalarında fQRS prevelansı kontrol grubuna göre anlamlı olarak daha yüksekti. FQRS bulunan şizofreni hastalarının kardiyovasküler olay sıklığını öngörmede kullanılabilir.

Keywords

• şizofreni
• brugada
• fragmente qrs

The Relations of Brugada ECG Pattern and Fraqmented QRS in Patient with Schizophrenia

Abstract

Objective: Schizophrenia is a psychiatric disease with high risk of fatal rhythm disorders and sudden cardiac death. A previous study reported that Brugada syndrome was highly prevelant in patients with schizophrenia. In this study we aimed to investigate the prevelance of Brugada syndrome and fraqmanted QRS in patients with schizophrenia. Methods: Two hundred and fifty patients with schizophrenia who were followed up in the psychiatry clinic, and 400 age- and sex-matched non schizophrenia controls were included. Standart ECGs and high intercostal ECGs with V1 and V2 derivation above two intercostal intervals were taken. Results: In schizophrenia patients, Type 1 Brugada syndrome was not observed, Type 2 Brugada was identified in one subject and Type 3 Brugada was observed in two patients. In the control group, Type 2 Brugada pattern was identified in one subject and again one control had Type 3 Brugada pattern(p=0.320). The fragmented QRS (fQRS) incidence, QRS duration and corrected QT were observed to be higher in the schizophrenia group compared to the control group (p=0.001, p=0.003, p<0.001, respectively). Conclusions:There is no increased prevalence of Brugada-ECG pattern in patients with schizophrenia. Importantly, the prevelance of fQRS was significantly higher in patients with schizophrenia compared to the control group. Fqrs can be used to estimate the frequency of cardiovascular events in patients with schizophrenia.

Keywords

• schizophrenia
• brugada
• fragmented qrs

References

1. 1- Soylu M, Duran Demir AD, Korkmaz Ş. Brugada Syndrome. Turk Kardiyol Dern Ars. 2003; 31(4): 219-225.
2. 2- Is Fragmented Qrs Associated with The Severity Of Carotid Artery Disease? Edem E. Reyhanoğlu H. Sakarya Med J. 2018;8(2):279-284
3. 3- Emul M, Kalelioglu T. Etiology of cardiovascular disease in patients with schizophrenia: current perspectives. Neuropsychiatr Dis Treat 2015; 11: 2493–503.
4. 4- Blom MT, Cohen D, Seldenrijk A, Penninx BW, Nijpels G, Stehouwer CD et al. Brugada syndrome ECG is highly prevalent in schizophrenia. Circ Arrhythm Electrophysiol 2014;7:384-91.
5. 5- Saha S, Chant D, McGRath J. A systematic review of mortality in schizophrenia. Arch Gen Psychiatry. 2007;64:1123–31.
6. 6- Appleby L, Thomas S, Ferrier N, G Lewis, J Shaw, T Amos. Sudden unexplained death in psychiatric in-patients. Br J Psychiatry 2000;176:405–06.
7. 7- Timour Q, Frassati D, Descotes J, Chevalier P, Christé G, ChahineM. Sudden death of cardiac origin and psychotropic drugs. Front Pharmacol 2012;3: 76.
8. 8- Ames D, Camm J, Cook P, P Falkai, C Gury, R Hurley, et al. Minimizing the risks associated with QTc prolongation in people with schizophrenia: A consensus statement by the Cardiac Safety in Schizophrenia Group. Australasian Psychiatry, 2002; 10: 2; 115-24

9. 9- Postema PG. About Brugada syndrome and its prevalence. Europace 2012;14:925-8.
10. 10- Alings M, Wilde A. Brugada syndrome: clinical data and suggested patho -physiological mechanism.Circulation 1999; 99: 666–73
11. 11- Yap YG, Behr ER, Camm AJ. Drug-induced Brugada syndrome. Europace 2009;11:989–94
12. 12- Pei J, Li N, Gao Y, Wang Z, Li X, Zhang Y et al. The J wave and fragmented QRS complexes in inferior leads associated with sudden cardiac death in patients with chronic heart failure. Europace 2012;14: 1180–87
13. 13- O’Driscoll DM, Horne RS, Davey MJ, Sarah A Hope, Vicki Anderson, John Trinder, et al. Increased sympathetic activity in children with obstructive sleep apnea: cardiovascular implications. Sleep Med 2011;12: 483–88
14. 14- Lecomte D, Fornes P, Fouret P, Nicolas G. Isolated myocardial fibrosis as a cause of sudden cardiac death and its possible relation to myocarditis. J Forensic Sci 1993; 3: 617-21
15. 15- Li JK, Yeung VT, Leung CM, Chow CC, Ko GT, So WY et al. Clozapine : a mimicry of phaeochromocytoma. Aust N Z Y Psychiatry1997;6: 889-91
16. 16- Ronaldson KJ.Cardiovascular Disease in Clozapine-Treated Patients: Evidence, Mechanismsm and Management. CNS Drugs 2017; doi: 10.1007/s40263-017-0461-9.
17. 17- Sha, J, Zhang S, Tang M, Keping Chen, Xinran Zhao, Fangzheng Wang . Fragmented QRS is associated with all-cause mortality and ventricular arrhythmias in patient with idiopathic dilated cardiomyopathy. Ann Noninvasive Electrocardiol 2011; 16: 270-5