Is there any evidence that atypical antipsychotics can lead to atrial fibrillation?
Notes about answers
If you see something you feel is wrong, don’t criticise (that misses the point of Triple) courteously and supportively give a counter answer.
Answers given should be in good faith, but they should not be considered definitive, be critical.
We do not endorse or verify content posted by users.
Thanks for your response,
Thanks for your question,
- Answered 6 Nov 2019 Conflict of interest declaration: None There seems to be mixed opinions on this! RCTs appear to show one thing (but may be underpowered) while a case-control appears to show an association! We found several general reviews that explored antipsychotics adverse events [1, 2, 3, 4] and none mentioned AF. A search of PubMed  found a few case reports and one case-control study “Antipsychotic treatment is associated with risk of atrial fibrillation: A nationwide nested case-control study”  (note it was for antipsychotics generally) and this reports: “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).” In the conclusion it does specify atypical antipsychotics: “This study demonstrated a significant association between antipsychotic exposure and the occurrence of AF, especially for certain atypical antipsychotic agents with higher cardiac muscarinic receptor binding affinity. Physicians should be aware of new-onset AF while prescribing such antipsychotic drugs to subjects with multiple medical comorbidities. When antipsychotic treatment is indicated, physicians should start with a low-dose prescription and with closely monitor of arrhythmia.” Finally, the AHRQ published, this year, “Antipsychotics for the Prevention and Treatment of Delirium”  and reports on one atypical antisychotic in relation to AF, stating: “One RCT, with low risk of bias and enrolling orthopedic surgery patients aged 65 years and older treated with 10 mg of oral olanzapine versus placebo in the perioperative period, reported no statistically significant between-group differences in arrhythmias or atrial fibrillation.” References 1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2327229/ 2) https://www.ncbi.nlm.nih.gov/pubmed/17927296 3) https://www.aafp.org/afp/2010/0301/p617.html 4) https://bpac.org.nz/BPJ/2011/november/docs/bpj_40_antipsychotics_pages_14-23.pdf 5) https://www.ncbi.nlm.nih.gov/pubmed?term=(%22Antipsychotic+Agents%22%5BMesh%5D)+AND+%22Atrial+Fibrillation%22%5BMesh%5D 6) https://www.ncbi.nlm.nih.gov/pubmed/27855291 7) https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/delirium-finalreport.pdf