Electrocardiographic Effects of Cholinesterase Inhibitors in Patients with Alzheimer’s Disease

Abstract

Aim:Cholinesterase inhibitors (ChEIs), such as donepezil and rivastigmine, are used safely in the treatment of Alzheimer’s disease (AD). However, the effects of these drugs on the cardiac conduction system are not clear. In this study, we aimed to investigate the effect of donepezil and rivastigmine treatment on the cardiac conduction system in comparison with the controls, especially on the QTc interval.Materials and Methods:We retrospectively enrolled 38 consecutive patients with AD, who were prescribed ChEIs for at least 3 months, and age, sex, and comorbidity-matched treatment-naive 37 control subjects. The electrocardiographic (ECG) parameters including heart rate, PR interval, QRS duration, QT interval, and QTc interval were recorded for each patient and control subject.Results:A total of 24 patients were enrolled in the donepezil treatment group, 14 patients in the rivastigmine treatment group, and 37 patients in the control group. Donepezil treatment resulted in significant prolongation in PR interval, QT interval and QTc interval (p=0.027, p=0.001, p=0.023, respectively). Rivastigmine treatment resulted in significant prolongation only in QTc interval (p=0.018). There was no significant difference between the donepezil and rivastigmine treatment groups for all ECG parameters.Conclusion:Donepezil and rivastigmine treatments significantly prolong QTc interval compared to controls in patients with AD. The donepezil treatment also prolongs PR and QT intervals. The donepezil and rivastigmine therapy had comparable effects on the cardiac conduction system.

Keywords

• alzheimer’s disease
• qtc prolongation
• donepezil
• rivastigmine