Associação entre o uso de medicamentos Antipsicóticos e o prolongamento do intervalo qt no eletrocardiograma em pacientes psiquiátricos: revisão sistemática com meta-análise

Abstract

The QT interval (QTc), an electrocardiographic parameter, is a non-invasive biomarker of ventricular repolarization, defined as the measurement from the beginning of the QRS complex to the end of the T wave, representing the total duration of ventricular electrical activity. QTc prolongation is an alteration of considerable clinical importance, as it predisposes individuals to torsades de pointes (TdP), a polymorphic ventricular tachycardia that can progress to sudden cardiac death. Several medications are associated with the risk of QT interval prolongation, including antipsychotics. Given this context, the objective of the present study is to investigate the association between the use of antipsychotic medications (both typical and atypical) and QT interval prolongation in psychiatric patients. To achieve this, a systematic literature review with a forest plot meta-analysis was conducted using the PubMed database, employing combinations of DeCS/MeSH descriptors. Only randomized clinical trials (RCTs) published between 2014 and 2024 in the English language were included. Article screening followed the PRISMA protocol, and the quality of evidence was assessed using the RevMan tool (Cochrane Institute). The studies demonstrated that medications such as Sertindole and high doses of Amisulpride are associated with significant increases in the QTc interval, while medications such as Quetiapine, Haloperidol, and Ziprasidone had minimal or clinically irrelevant impact. Factors such as sex, genetics (SCN5A gene and SNP rs1006737), and dosage directly influence QTc prolongation, with a higher risk observed in women and predisposed individuals. Thus, a significant association was found between the use of Amisulpride (40 mg - 23.4/ms), Amisulpride (5 mg) + Moxifloxacin (400 mg - 12.3/ms), and Sertindole (12.1/ms) in relation to QT interval prolongation in psychiatric patients, especially when variables such as sex, age, and genetics are considered. On the other hand, the antipsychotics Laquinimod (0.6 mg - 1.0/ms) and Quetiapine (-0.5/ms) did not show significant variations in QTc prolongation. Further studies are needed to assess other types of antipsychotics, specific pathophysiological mechanisms, differences in age and gender, as well as pre-existing medical conditions, to expand the scientific scope on the subject.