TY - JOUR
T1 - Stimulant therapy in children with attention-deficit/hyperactivity disorder and concomitant long QT syndrome
T2 - A safe combination?
AU - Rohatgi, Ram K.
AU - Bos, J. Martijn
AU - Ackerman, Michael J.
N1 - Funding Information:
This work was supported by the Mayo Clinic Windland Smith Rice Comprehensive Sudden Cardiac Death Program to Dr. Ackerman and CTSA Grant No. UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH. Dr. Ackerman is a consultant for Boston Scientific, Gilead Sciences, Medtronic, St. Jude Medical, and Transgenomic. Intellectual property derived from Dr. Ackerman’s research program resulted in license agreements in 2004 between Mayo Clinic Ventures and Genaissance Pharmaceuticals (now Transgenomic) with respect to their FAMILION-LQTS and FAMILION-CPVT genetic tests.
Publisher Copyright:
© 2015 Heart Rhythm Society. All rights reserved.
PY - 2015/8/1
Y1 - 2015/8/1
N2 - Background Attention-deficit/hyperactivity disorder (ADHD) is prevalent in about 11% of children in the United States. As such, ADHD is expected to be present in patients with long QT syndrome (LQTS), a rare, potentially lethal but highly treatable cardiac channelopathy. ADHD-directed stimulant therapy is relatively contraindicated in patients with LQTS because of concern for LQTS-triggered events. Objective The purpose of this study was to evaluate the ADHD-directed treatment, outcome, and frequency of LQTS-triggered events in patients with LQTS and concomitant ADHD. Methods A retrospective electronic medical record review of 357 pediatric patients with LQTS evaluated between 1999 and 2014 was performed to determine the prevalence of concomitant ADHD and the incidence of LQTS-triggered events in patients with LQTS, with or without concomitant ADHD. Results Overall, 28 patients (8%) were diagnosed with LQTS concomitant ADHD. There were no phenotypic differences between patients with LQTS and ADHD, and LQTS alone. ADHD-directed stimulant therapy was stopped or advised against in 19 patients (68%) at the time of first evaluation or after diagnosis. None of the 15 stimulant-treated patients experienced LQTS-triggered events in a combined 56 person-years of treatment. Perhaps paradoxically, there was a statistically lower LQTS-triggered event rate in the stimulant-treated ADHD group compared to the LQTS alone cohort. Conclusion Among patients with mild- to moderate-risk LQTS, we found a prevalence of ADHD similar to that in the general population, which can be treated effectively and safely with stimulant therapy. Physicians should find reassurance in the low adverse event rate and should weigh the potential effects of suboptimal treatment of ADHD with the theoretical proarrhythmic risk from stimulant medications.
AB - Background Attention-deficit/hyperactivity disorder (ADHD) is prevalent in about 11% of children in the United States. As such, ADHD is expected to be present in patients with long QT syndrome (LQTS), a rare, potentially lethal but highly treatable cardiac channelopathy. ADHD-directed stimulant therapy is relatively contraindicated in patients with LQTS because of concern for LQTS-triggered events. Objective The purpose of this study was to evaluate the ADHD-directed treatment, outcome, and frequency of LQTS-triggered events in patients with LQTS and concomitant ADHD. Methods A retrospective electronic medical record review of 357 pediatric patients with LQTS evaluated between 1999 and 2014 was performed to determine the prevalence of concomitant ADHD and the incidence of LQTS-triggered events in patients with LQTS, with or without concomitant ADHD. Results Overall, 28 patients (8%) were diagnosed with LQTS concomitant ADHD. There were no phenotypic differences between patients with LQTS and ADHD, and LQTS alone. ADHD-directed stimulant therapy was stopped or advised against in 19 patients (68%) at the time of first evaluation or after diagnosis. None of the 15 stimulant-treated patients experienced LQTS-triggered events in a combined 56 person-years of treatment. Perhaps paradoxically, there was a statistically lower LQTS-triggered event rate in the stimulant-treated ADHD group compared to the LQTS alone cohort. Conclusion Among patients with mild- to moderate-risk LQTS, we found a prevalence of ADHD similar to that in the general population, which can be treated effectively and safely with stimulant therapy. Physicians should find reassurance in the low adverse event rate and should weigh the potential effects of suboptimal treatment of ADHD with the theoretical proarrhythmic risk from stimulant medications.
KW - Attention-deficit/hyperactivity disorder
KW - Long QT syndrome
KW - Stimulant therapy
UR - http://www.scopus.com/inward/record.url?scp=84937524952&partnerID=8YFLogxK
U2 - 10.1016/j.hrthm.2015.04.043
DO - 10.1016/j.hrthm.2015.04.043
M3 - Article
C2 - 25956966
AN - SCOPUS:84937524952
SN - 1547-5271
VL - 12
SP - 1807
EP - 1812
JO - Heart Rhythm
JF - Heart Rhythm
IS - 8
ER -