Associazione Nazionale Medici Cardiologi Ospedalieri



Cardiovascular Considerations in Antidepressant Therapy: Sinus arrest due to sertraline.

Scollo Claudio Chieti(Chieti) – Cardiologia Universitaria “G. d’Annunzio” Chieti | Rossi Davide Chieti(Chieti) – Cardiologia Universitaria “G. d’Annunzio” Chieti | D’Andria Roberta Chieti(Chieti) – Cardiologia Universitaria “G. d’Annunzio” Chieti

A 39-year-old Caucasian woman with a silent cardiac anamnesis and no family history of cardiovascular diseases, and a history of mood disorder treated with Sertraline for about 1 month, went to the Emergency Department reporting several syncopal episode, all with rapid and complete recovery of consciousness.

In the Emergency Department, another syncopal episode occurred in the supine position, characterized by sinus bradycardia evolving into a brief asystole, with spontaneous restoration of normal sinus rhythm. Admitted to the Cardiovascular Intensive Care Unit, the patient showed no abnormalities in laboratory testsas well as in echocardiography results.

The patient received appropriate hydration, and home medication was discontinued. A non-contrast head CT scan showed no acute lesions. Cardiac MR revealed normal morpho-functional findings, with no evidence of myocardial edema or pericardial effusion and no pathological late gadolinium enhancement areas. Brain MRI demonstrated normal anatomical and functional findings, with no signal abnormalities.

Considering the patient ‘s young age and the suspicion of an iatrogenic origin of the rhythm disorder, the decision to postpone pacemaker implantation was made, and cardiac electrical activity was monitored using a loop recorder.

At the one-month follow-up, the patient, who had been off Sertraline since admission, was in good health, reporting no further syncopal or pre-syncopal episodes. Loop recorder monitoring revealed no significant arrhythmias.

The only relevant anamnestic data was the use of Sertraline, and the application of the Adverse Drug Reaction Probability Scale suggests that the iatrogenic origin of this event as a pharmacological adverse effect is at least probable (score: 7).

Limited literature connects Sertraline directly to documented cases of asystole, but reports indicate that drugs in the same pharmacological class may induce cardiac rhythm disturbances, including tachyarrhythmias and bradyarrhythmias.

This case draws attention to sinus arrest during sertraline therapy and how an appropriate pharmacological washout led to the resolution of the pathology.