Electrocardiographic abnormalities as predictors for over-range lithium levels

Chih Hsin Hsu, Ping Yen Liu, Jyh Hong Chen, Tzung Lieh Yeh, Hsiang Yi Tsai, Li Jen Lin

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Background: Lithium compounds have been widely used in the treatment of manic-depressive illness. Several electrocardiogram (ECG) abnormalities, including ventricular arrhythmias, atrioventricular conduction abnormalities, T wave changes and QT interval prolongation, have been reported to be associated with lithium. However, the correlation between serum lithium levels and ECG changes has never been characterized in a systematic way. Methods: This retrospective study included 76 patients undergoing lithium treatment with available records of lithium levels. Eleven patients (4 men) had serum lithium levels >1.2 mEq/l and were diagnosed as lithium over range. Clinical characteristics and various ECG changes were analyzed in patients with and without lithium over range. Results: Patients with lithium over range had a slower heart rate and longer PR, QT and corrected QT (QTc) intervals. QTc interval >440 ms was more commonly found in patients with lithium over range (55 vs. 8%, p < 0.001). Similarly, diffuse T wave inversion was more commonly associated with lithium over range (73 vs. 17%, p < 0.001). The daily dosage of lithium was similar between patients with and without over-range lithium levels. When these two ECG changes were combined, the sensitivity and specificity in predicting lithium over range were 64 and 97%, respectively. These findings were independent of the concomitant use of β-blockers. Conclusions: QTc interval >440 ms and diffuse T wave inversion were significantly more common in patients with lithium over range, and were good predictors of lithium over range. More liberal checkup of the ECG in patients undergoing lithium treatment may be of help in the early detection of lithium over range.

Original languageEnglish
Pages (from-to)101-106
Number of pages6
JournalCardiology
Volume103
Issue number2
DOIs
Publication statusPublished - 2005 Mar 7

Fingerprint

Lithium
Electrocardiography
Lithium Compounds
Serum
Cardiac Arrhythmias
Therapeutics
Retrospective Studies
Heart Rate

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)

Cite this

Hsu, Chih Hsin ; Liu, Ping Yen ; Chen, Jyh Hong ; Yeh, Tzung Lieh ; Tsai, Hsiang Yi ; Lin, Li Jen. / Electrocardiographic abnormalities as predictors for over-range lithium levels. In: Cardiology. 2005 ; Vol. 103, No. 2. pp. 101-106.
@article{cebe08de92de4455854c7f94d696a7cf,
title = "Electrocardiographic abnormalities as predictors for over-range lithium levels",
abstract = "Background: Lithium compounds have been widely used in the treatment of manic-depressive illness. Several electrocardiogram (ECG) abnormalities, including ventricular arrhythmias, atrioventricular conduction abnormalities, T wave changes and QT interval prolongation, have been reported to be associated with lithium. However, the correlation between serum lithium levels and ECG changes has never been characterized in a systematic way. Methods: This retrospective study included 76 patients undergoing lithium treatment with available records of lithium levels. Eleven patients (4 men) had serum lithium levels >1.2 mEq/l and were diagnosed as lithium over range. Clinical characteristics and various ECG changes were analyzed in patients with and without lithium over range. Results: Patients with lithium over range had a slower heart rate and longer PR, QT and corrected QT (QTc) intervals. QTc interval >440 ms was more commonly found in patients with lithium over range (55 vs. 8{\%}, p < 0.001). Similarly, diffuse T wave inversion was more commonly associated with lithium over range (73 vs. 17{\%}, p < 0.001). The daily dosage of lithium was similar between patients with and without over-range lithium levels. When these two ECG changes were combined, the sensitivity and specificity in predicting lithium over range were 64 and 97{\%}, respectively. These findings were independent of the concomitant use of β-blockers. Conclusions: QTc interval >440 ms and diffuse T wave inversion were significantly more common in patients with lithium over range, and were good predictors of lithium over range. More liberal checkup of the ECG in patients undergoing lithium treatment may be of help in the early detection of lithium over range.",
author = "Hsu, {Chih Hsin} and Liu, {Ping Yen} and Chen, {Jyh Hong} and Yeh, {Tzung Lieh} and Tsai, {Hsiang Yi} and Lin, {Li Jen}",
year = "2005",
month = "3",
day = "7",
doi = "10.1159/000082471",
language = "English",
volume = "103",
pages = "101--106",
journal = "Cardiology",
issn = "0008-6312",
publisher = "S. Karger AG",
number = "2",

}

Electrocardiographic abnormalities as predictors for over-range lithium levels. / Hsu, Chih Hsin; Liu, Ping Yen; Chen, Jyh Hong; Yeh, Tzung Lieh; Tsai, Hsiang Yi; Lin, Li Jen.

In: Cardiology, Vol. 103, No. 2, 07.03.2005, p. 101-106.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Electrocardiographic abnormalities as predictors for over-range lithium levels

AU - Hsu, Chih Hsin

AU - Liu, Ping Yen

AU - Chen, Jyh Hong

AU - Yeh, Tzung Lieh

AU - Tsai, Hsiang Yi

AU - Lin, Li Jen

PY - 2005/3/7

Y1 - 2005/3/7

N2 - Background: Lithium compounds have been widely used in the treatment of manic-depressive illness. Several electrocardiogram (ECG) abnormalities, including ventricular arrhythmias, atrioventricular conduction abnormalities, T wave changes and QT interval prolongation, have been reported to be associated with lithium. However, the correlation between serum lithium levels and ECG changes has never been characterized in a systematic way. Methods: This retrospective study included 76 patients undergoing lithium treatment with available records of lithium levels. Eleven patients (4 men) had serum lithium levels >1.2 mEq/l and were diagnosed as lithium over range. Clinical characteristics and various ECG changes were analyzed in patients with and without lithium over range. Results: Patients with lithium over range had a slower heart rate and longer PR, QT and corrected QT (QTc) intervals. QTc interval >440 ms was more commonly found in patients with lithium over range (55 vs. 8%, p < 0.001). Similarly, diffuse T wave inversion was more commonly associated with lithium over range (73 vs. 17%, p < 0.001). The daily dosage of lithium was similar between patients with and without over-range lithium levels. When these two ECG changes were combined, the sensitivity and specificity in predicting lithium over range were 64 and 97%, respectively. These findings were independent of the concomitant use of β-blockers. Conclusions: QTc interval >440 ms and diffuse T wave inversion were significantly more common in patients with lithium over range, and were good predictors of lithium over range. More liberal checkup of the ECG in patients undergoing lithium treatment may be of help in the early detection of lithium over range.

AB - Background: Lithium compounds have been widely used in the treatment of manic-depressive illness. Several electrocardiogram (ECG) abnormalities, including ventricular arrhythmias, atrioventricular conduction abnormalities, T wave changes and QT interval prolongation, have been reported to be associated with lithium. However, the correlation between serum lithium levels and ECG changes has never been characterized in a systematic way. Methods: This retrospective study included 76 patients undergoing lithium treatment with available records of lithium levels. Eleven patients (4 men) had serum lithium levels >1.2 mEq/l and were diagnosed as lithium over range. Clinical characteristics and various ECG changes were analyzed in patients with and without lithium over range. Results: Patients with lithium over range had a slower heart rate and longer PR, QT and corrected QT (QTc) intervals. QTc interval >440 ms was more commonly found in patients with lithium over range (55 vs. 8%, p < 0.001). Similarly, diffuse T wave inversion was more commonly associated with lithium over range (73 vs. 17%, p < 0.001). The daily dosage of lithium was similar between patients with and without over-range lithium levels. When these two ECG changes were combined, the sensitivity and specificity in predicting lithium over range were 64 and 97%, respectively. These findings were independent of the concomitant use of β-blockers. Conclusions: QTc interval >440 ms and diffuse T wave inversion were significantly more common in patients with lithium over range, and were good predictors of lithium over range. More liberal checkup of the ECG in patients undergoing lithium treatment may be of help in the early detection of lithium over range.

UR - http://www.scopus.com/inward/record.url?scp=14044252792&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=14044252792&partnerID=8YFLogxK

U2 - 10.1159/000082471

DO - 10.1159/000082471

M3 - Article

C2 - 15591709

AN - SCOPUS:14044252792

VL - 103

SP - 101

EP - 106

JO - Cardiology

JF - Cardiology

SN - 0008-6312

IS - 2

ER -