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Effects of opioid receptor agonist and antagonist medications on electrocardiogram changes and presentation of cardiac arrhythmia: review article

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Abstract

Background/Purpose

Mortality associated with prescription opioids has significantly increased over the past few decades and is considered a global pandemic. Prescribed opioids can cause cardiac arrhythmias, leading to fatal outcomes and unexpected death, even in the absence of structural cardiac disease. Despite the extent of cardiac toxicity and death associated with these medications, there is limited data to suggest their influences on cardiac electrophysiology and arrhythmias, with the exception of methadone. The goal of our review is to describe the possible mechanisms and to review the different ECG changes and arrhythmias that have been reported.

Methods

A literature search was performed using Google Scholar, PubMed, Springer, Ovid, and Science Direct to identify studies that demonstrated the use of prescription opioids leading to electrocardiogram (ECG) changes and cardiac arrhythmias.

Results

Many of the commonly prescribed opioid medications can uniquely effect the ECG, and can lead to the development of various cardiac arrhythmias. One of the most significant side effects of these drugs is QTc interval prolongation, especially when administered to patients with a baseline risk for QTc prolongation. A prolonged QTc interval can cause lethal torsades de pointes and ventricular fibrillation. Obtaining an ECG at baseline, following a dosage increase, or after switching an opioid medication, is appropriate in patients taking certain prescribed opioids. Opioids are often used first line for the treatment of acute and chronic pain, procedural sedation, medication opioid use disorders, and maintenance therapy.

Conclusions

To reduce the risk of cardiac arrhythmias and to improve patient outcomes, consideration of accurate patient selection, concomitant medications, electrolyte monitoring, and vigilant ECG monitoring should be considered.

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Authors and Affiliations

  1. Department of Medicine, Yale University, New Haven, CT, USA

    Farshid Etaee

  2. Saint Joseph Hospital, Lexington, KY, USA

    Morgan Tobin & Claude S. Elayi

  3. Department of Medicine, UT Southwestern Medical Center, Dallas, TX, USA

    Suchith Vuppala

  4. Neurophysiology Research Center, Hamadan, Iran

    Alireza Komaki

  5. Saha Cardiovascular Research Center, University of Kentucky College of Medicine, Lexington, KY, USA

    Brian P. Delisle

  6. Montefiore Medical Center, Bronx, NY, USA

    Luigi Di Biase

  7. University of Florida – Jacksonville, Jacksonville, FL, USA

    John N Catanzaro

  8. Texas Cardiac Arrhythmia Institute, Austin, TX, USA

    Andrea Natale

  9. Electrophysiology Service, CHI Saint Joseph Medical Group, 1401 Harrodsburg Road, Suite A 300, Lexington, KY, 40504, USA

    Claude S. Elayi

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  1. Farshid Etaee
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Correspondence to Claude S. Elayi.

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Etaee, F., Tobin, M., Vuppala, S. et al. Effects of opioid receptor agonist and antagonist medications on electrocardiogram changes and presentation of cardiac arrhythmia: review article. J Interv Card Electrophysiol 63, 471–500 (2022). https://doi.org/10.1007/s10840-021-01072-1

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  • DOI: https://doi.org/10.1007/s10840-021-01072-1

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