CARDIOVASCULAR REPERCUSSIONS OF SEIZURES DURING CYCLIC ANTIDEPRESSANTPOISONING

Cyclic antidepressant overdose involves a risk of generalized seizures and cardiovascular disturbances. We have conducted a retrospective st udy to test the hypothesis of a relationship between generalized seizu res and the onset of arrhythmia, hypotension or cardiac arrest during cyclic antidepressant intoxication. Patients who had seizures after in gestion of toxic amounts of tri- or tetracyclic antidepressants were i ncluded. Limb-lead QRS complex duration and systolic blood pressure we re recorded before and after seizure. Twenty-four of the 388 patients (6.2%) who were admitted to our ICU over a four-year period had seizur es (2.3 +/- 2 seizures/patient). Cardiac repercussions of cyclic-induc ed seizure were frequent and severe. In the postictal period, broadeni ng of the QRS duration or hypotension occurred or were exacerbated in at least 41% and 29% of cases, respectively. In three patients (12.5%) , the seizure-induced cardiovascular state was life-threatening and re quired massive alkalinization therapy and vasopressors, and two of the three required cardiac massage or cardioversion. Prior to seizure, th ese three patients had severe intoxications characterized by QRS durat ion greater than or equal to 120 ms and systolic blood pressure less t han or equal to 80 mm Hg. The results of this work confirm the potenti al risk of cardiovascular deterioration after cyclic antidepressant-in duced seizure and raise the question of a prophylactic approach especi ally towards the subgroup with unstable hemodynamic status.