Increased prevalence of ECG suspicious for Brugada Syndrome in recent onset schizophrenia spectrum disorders

Background: Schizophrenia is associated with an increased risk of sudden cardiac death, traditionally attributed to
prolongedQTc interval and increasedprevalence of cardiovascular risk factors. However, defective ion channels implicated
in both schizophrenia and Brugada Syndrome (BrS)may be associated with an increased risk of cardiac arrhythmias.
Moreover, these cardiac arrhythmias can be provoked by various drugs, including psychotropic drugs.
Objective: To assess the prevalence of the occurrence of ECG suspicious for BrS (suspect BrS-ECG) and the prevalence
of BrS in patients with recent onset schizophrenia spectrum disorders (SSD).
Methods: In this case-control study, ECGs of 388 patients with recent onset SSD admitted between 2006 and 2015
and 844 healthy controls weremade. All persons who had a suspect BrS-ECG were offered an ajmaline provocation
test to diagnose or exclude BrS. Data on possible confounders were ascertained. Patients with and without suspect
BrS-ECG were compared regarding clinical and ECG variables.
Results: Suspect BrS-ECG was found in 33 patients (8.5%) and 13 healthy controls (1.5%),with an adjustedOdds Ratio of
3.5 (p b 0.0001). This findingwas not explained by potential confounders such as gender, age, ethnicity, cannabis use,
cardiovascular risk factors, medication use or serum electrolytes. BrSwas confirmed in three patients and one control.
Conclusion: A considerable subset of patientswith recent onset SSD have suspect BrS-ECG, extending earlier findings in
patients with chronic schizophrenia. Screening for BrS in schizophrenia could be relevant both to prevent sudden cardiac
death and to identify a subgroup of patients with possible ion-channel dysfunctioning.