Is valproate promising in cardiac fatal arrhythmias? Comparison of P- and Q-wave dispersion in bipolar affective patients on valproate or lithium–valproate maintenance therapy with healthy controls

• Published in: Journal of psychopharmacology (Oxford) Vol. 23; no. 3; pp. 328 - 333
• Main Authors: E, Kurt, M, Emul, O, Ozbulut, O, Guler, F, Erdur, H, Sağlam, O, Gecici
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-05-2009; Sage Publications; Sage Publications Ltd
• Subjects: Adult; Adult and adolescent clinical studies; Antimanic Agents - pharmacology; Antimanic Agents - therapeutic use; Arrhythmia; Arrhythmias, Cardiac - prevention & control; Biological and medical sciences; Bipolar disorder; Bipolar Disorder - drug therapy; Bipolar Disorder - physiopathology; Bipolar disorders; Cardiac dysrhythmias; Cardiology. Vascular system; Conduction; Cross-Sectional Studies; Drug Therapy, Combination; EKG; Electrical conduction; Electrocardiography; Female; Heart; Heart diseases; Humans; Lithium; Lithium Compounds - pharmacology; Lithium Compounds - therapeutic use; Male; Medical sciences; Middle Aged; Mood; Mood disorders; Neuropharmacology; Patients; Pharmacology. Drug treatments; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychopharmacology; Statistical analysis; Valproic acid; Valproic Acid - pharmacology; Valproic Acid - therapeutic use; Ventricle; Wave dispersion; Young Adult; QTc; valproate; bipolar disorder; P-wave dispersion; P-wave duration; QT dispersion; Heart; Affect affectivity; Arrhythmia; Psychotropic; Cardiovascular disease; Lithium; Bipolar disorder; Anticonvulsant; Mood stabilizer; Heart disease; Maintenance treatment; Mood disorder; QT interval; 4-Aminobutyrate transaminase; Enzyme; Transferases; Enzyme inhibitor; Duration; Valproic acid; Histone deacetylase inhibitor; Nootropic agent; Transaminases; Death; Circulatory system; Comparative study
• ISSN: 0269-8811; 1461-7285
• DOI: 10.1177/0269881108089594

Abstract
Autonomic nerve system is considered to be involved in bipolar affective disorder (BAD) or to be influenced by valproate monotherapy or valproate plus lithium combination. We planned to assess the effects of medication on atrial and ventricular conduction. The electrocardiography records were performed with eligible 15 patients with valproate, 20 patients with lithium–valproate combination use in euthymic phases of BAD and 20 healthy participants. The blood valproate and lithium concentrations in groups were in normal range. The difference in P maximum, P minimum, maximum QTc were statistically insignificant. Minimum QTc (F = 6.36; df = 2; P = 0.003) and QT dispersion (QTD) (F = 5.57; df = 2; P = 0.006) were statistically significant among the groups. There were no significant differences between patient groups among ECG parameters. Minimum QTc was significantly longer in combination group than healthy controls, whereas the QTD values in both patient groups were significantly lower than controls’. Valproate might have some preventive effects on ventricular electrical conduction because of lower QTD in both patient groups. Thus, valproate seems to have cardiac conduction stabilizing effect beside its mood stabilizing aspect. However, this finding needs replication and further corroboration in well-designed studies.