ACUTE EFFECTS OF SYNTHETIC CANNABINOIDS ON VENTRICULAR REPOLARIZATION

Berat Uguz, Selma Tiryakioglu, Evren Dal, Aysu Kivrak Tihan, Kivanc Yalin, Hakan Ozkan

Abstract


Objective: The usage of synthetic cannabinoids (SCs) has increased both in Turkey and all worldwide. Here, we evaluate if SCs cause ventricular repolarization abnormalities using initial and after 12th-hour electrocardiograms in patients with acute intoxication of SCs. We examined changes in the QTc and cTp-e parameters to demonstrate ventricular repolarization effects of the usage of SCs.

Material and Methods: We used a prospective study design. Twenty patients were included who visited the emergency department, complaining of clouding of consciousness after using SCs. The QT, QTc and Tp-e intervals and several other electrocardiographic parameters were measured at baseline and 12 hours after the usage of  SCs.

Results: The QRS duration was significantly decreased (102.1±15.5 ms vs 95.0±10.7 ms; p=0.022). We noted a significant decrease in cQT measurements at the end of the 12th hour (426.6±47.2 ms vs 390.4±42.9 ms; p=0.002). Similarly, the Tp-e and cTp-e values decreased significantly when SCs lost its acute effect (93.4±21.1 ms vs 77.4±21.0 ms; p=0.014, 105.3±28.5 ms vs 88.1±21.5 ms; p=0.01).

Conclusions: The usage of SCs affects ventricular repolarization heterogeneity based on  QTc and Tp-e intervals.


Keywords


Synthetic cannabinoids, Bonzai, ventricular repolarization heterogeneity, adverse cardiovascular effects

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References


EMCDDA. Synthetic perspectives on drugs. Cannabinoids in Europe. http://www.emcdda.europe.eu/attachements.cfm/att_212361_EN_EMCDDA_POD_2013-synthetic%20cannabinoids.pdf.

Evren C, Bozkurt M. Sentetik kannabinoidler: Son yollarin krizi. Dusunen Adam The Journal Of Psychiatry and Neurological Sciences. 2013; 26(1): 1–11.

Lewin AH, Seltzman HH, Caroll FI, Mascarella SW, Reddy A. Emergence and properties of spice and bath salts. A medicinal chemistry perspective. Life Sci 2014; 97(1): 9–19.

Gurdal F, Asirdizer N, Aker RG, Korkut S, Gocer Y, Kucukibrahimoglu EE et al. Review of detection frequency and type of synthetic cannabinoids in herbal compounds analyzed by İstanbul Narcotic Department of the council of Forensic Medicine, Turkey. J Forensic Leg Med. 2013; 20(6): 667–72.

Bozkurt M, Umut G, Evren C, Karabulut V. Sentetik kannabinoid kullanimi nedeniyle poliklinige basvuran hastalarin klinik ozellikleri ve laboratuvar sonucları. Dusunen Adam The Journal Of Psychiatry and Neurological Sciences. 2014; 27: 328–34.

Hoyte CO, Jacob J, Monte AA, Al-Jumaan M, Bronstein AC, Heard KJ. Characterization of synthetic cannabinoids exposures reported to the National Poison Data system in 2010. Ann Emerg Med. 2012; 60(4): 435–8.

Al Kury LT, Voitychuk OI, Yang KH, Thayyullathil FT, Doroshenko P, Ramez AM, et al. Effects of the endegenous cannabinoid anandamide on voltage-dependent sodium and calcium channels in rat ventricular myocytes. Br J Pharmacol. 2014; 171(14): 3485–98.

Krylatov AV, Maslov LN, Ermakov SYu, Lasukova OV, Barzakh EI, Crawford D, et al. Significance of cardiac cannabinoid receptors in regulation of cardiac rhythm, myocardial contractility and electrophysiologic processes in heart. Izvestiya Akademii Nauk, Seriya Biologicheskaya. 2007; 1: 35–44.

Hermanns-Clausen M, Kneisel S, Szabo B, Auwarter V. Acute toxicity due to the confirmed consumption of synthetic cannabinoids: clinical and laboratory findings. Addiction 2013; 108(3): 534–44.

Huffman JW, Padgett LW. Recent developments in the medical chemistry of cannabinomimetic indoles, pyrroles and indices. Curr Med Chem. 2005; 12(12): 1395–441.

Atık SU, Dedeoglu R, Varol F, Cam H, Eroglu AG, Saltık L. Cardiovascular side effect related with use of synthetic cannabinoids 'Bonzai': two case reports. Turk Pediatri Ars. 2015; 50(1): 61–4.

Mittleman MA, Lewis RA, Malcolm M, Sherwood JB, Muller JE. Triggering myocardial infarction by marijuana Circulation. 2001;103(23):2805–9.

Young AC, Schwarz E, Medina G, Obafemi A, Feng S, Kane C, et al. Cardiotoxicity associated with the synthetic cannobinoid ,K9; with laboratory confirmation. Am J Emerg Med. 2012; 30(7): 1320.e5–7. doi: 10.1016/j.ajem.2011.05.013.

Von Der Haar J, Talebi S, Ghobadi F, Singh S, Chirurgi R, Rajeswari P, et al. Synthetic cannabinoids and their effects on the cardiovascular system. J Emerg Med. 2016; 50(2): 258–62.

Kucuk E, Kucuk I, Yildiz Y, Kirazaldi YY. Acil serviste yeni bir tehlike: Sentetik kannabinoidler (Bonzai, Jameika). Genel Tıp Derg. 2015; 25: 18–22.

Bui QM, Simpson S, Nordstam K. Psychiatric and medical management of marijuana intoxication in the emergency department. West J Emerg Med. 2015; 16(3): 414–7.

Sicouri S, Atzelevitch C. A subpopulation of cells with unique electrophysiological properties in the deep subepicardium of the canine ventricle. The M Cell Circ Res. 1991; 68(6): 1729–41.

Mac Cornack FA. The effects of coffee drinking on the cardiovascular system: experimental and epidemiological research. Prev Med. 1977; 6(1): 104–19.

Shimizu M, Ino H, Okeie K, Yamaguchi M, Nagata M, Hayashi K.et al. T-peak to T-end interval may be a better predictor of high risk patients with hypertrophic cardiomyopathy associated with cardiac troponin I mutation than QT dispersion. Clin Cardiol. 2002; 25(7): 335–9.

Golcuk E, Yalın K, Kaya BA, Elitok A, Aksu T, Karaayvaz B, et al. Usefulness of T(peak)-T(end) interval to distinguish arrhythmogenic right ventricular cardiomyopathy from idiopathic right ventricular outflow tract tachycardia. Pacing Clin Electrophysiol. 2014; 37(12): 1665–70.




DOI: http://dx.doi.org/10.24125/sanamed.v15i3.453

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