Antipsychotic drugs are associated with pulseless electrical activity: the Oregon Sudden Unexpected Death Study

Heart Rhythm. 2013 Apr;10(4):526-30. doi: 10.1016/j.hrthm.2012.12.002. Epub 2012 Dec 6.


Background: There has been a paradigm shift in the manifestation of sudden cardiac arrest (SCA), with steadily decreasing rates of ventricular fibrillation/tachycardia (VF/VT) and a significant increase in the proportion of pulseless electrical activity (PEA) and asystole.

Objective: Since PEA is marked by failure of myocardial contractility, we evaluated the potential role of drugs that affect cardiac contractility in the pathophysiology of human PEA.

Methods: Subjects with out-of-hospital SCA (aged≥18 years) who underwent attempted resuscitation were evaluated in the ongoing Oregon Sudden Unexpected Death Study (2002-2009). Specific classes of medications with either negative or positive cardiac inotropic effects were evaluated for association with occurrence of PEA vs VF/VT by using Pearson χ(2) tests and logistic regression.

Results: PEA cases (n = 309) were older than VF/VT cases (n = 509; 68±14 years vs 64±15 years; P<.0001) and were more likely to be women (39% vs 25%; P<.0001). In a logistic regression model adjusting for age, sex, comorbidities, disease burden, and resuscitation variables, antipsychotic drugs (odds ratio 2.40; 95% confidence interval 1.26-4.53) were significant predictors of PEA vs VF/VT. Conversely, use of digoxin was associated with the occurrence of VF/VT (P<.0001).

Conclusions: When drugs modifying myocardial contractility were evaluated in a comprehensive analysis of patients who suffered SCA, use of antipsychotic agents was a significant and independent predictor of manifestation with PEA.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Antipsychotic Agents / adverse effects*
  • Antipsychotic Agents / therapeutic use
  • Cardiopulmonary Resuscitation / methods
  • Causality
  • Cause of Death
  • Cohort Studies
  • Confidence Intervals
  • Death, Sudden, Cardiac / epidemiology*
  • Electrocardiography*
  • Female
  • Heart Arrest
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Oregon
  • Out-of-Hospital Cardiac Arrest / chemically induced*
  • Out-of-Hospital Cardiac Arrest / epidemiology*
  • Retrospective Studies
  • Severity of Illness Index
  • Sex Distribution
  • Survival Analysis
  • Tachycardia, Ventricular / chemically induced
  • Tachycardia, Ventricular / diagnosis
  • Tachycardia, Ventricular / mortality
  • Tachycardia, Ventricular / therapy
  • Ventricular Fibrillation / chemically induced
  • Ventricular Fibrillation / diagnosis
  • Ventricular Fibrillation / mortality
  • Ventricular Fibrillation / therapy


  • Antipsychotic Agents