European Journal of Pediatrics

, Volume 175, Issue 8, pp 1129–1132 | Cite as

A neonatal prolonged QT syndrome due to maternal use of oral tricyclic antidepressants

  • Naoya Fukushima
  • Kenji Nanao
  • Hiroyuki Fukushima
  • Akira Namera
  • Masaru MiuraEmail author
Case Report


It is known that tricyclic antidepressants induce long QT intervals associated with forms of life-threatening arrhythmia such as torsades de pointes (TdP), and these adverse effects may also occur in neonates whose mothers take tricyclic antidepressants. We report a neonatal case of prolonged QT interval and TdP caused by clomipramine that was transferred transplacentally from the mother. Administration of magnesium sulfate was effective to abolish TdP.

Conclusion: When mothers take tricyclic antidepressants during pregnancy, their newborns should be watched carefully for drug-induced long QT syndrome and TdP.

What is Known:

Tricyclic antidepressant can prolong the QT interval. It may be used for depression in pregnancy.

What is New:

This is the first neonatal case report of prolonged QT interval and TdP caused by clomipramine transferred transplacentally from the mother.


Clomipramine Desmethylclomipramine Placental passage Prolonged QT interval Torsades de Pointes 



Action potential duration


Early afterdepolarizations


Long QT syndrome


Torsades de pointes


Authors’ contributions

Naoya Fukushima wrote the paper. Naoya Fukushima and Masaru Miura revised the manuscript. Naoya Fukushima, Kenji Nanao, and Hiroyuki Fukushima were the attending pediatrician. Akira Namera performed the quantitative liquid chromatographic analysis of plasma concentrations of clomipramine and desmethylclomipramine.

Compliance with ethical standards

All procedures performed in study involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Chiang CE (2004) Congenital and acquired long QT syndrome. Current concepts and management. Cardiol Rev 12:222–234CrossRefPubMedGoogle Scholar
  2. 2.
    Evans LEJ, Bett JH, Cox JR, Dubois JP, Van Hees T (1980) The bioavailability of oral and parenteral chlorimipramine. Prog Neuro-Psychopharmacol 4:293–302JCrossRefGoogle Scholar
  3. 3.
    Jo SH, Hong HK, Chong SH, Won KH, Jung SJ, Choe H (2008) Clomipramine block of the hERG K+ channel: accessibility to F656 and Y652. Eur J Pharmacol 592:19–25CrossRefPubMedGoogle Scholar
  4. 4.
    Kaseda S, Gilmour RF Jr, Zipes DP (1989) Depressant effect of magnesium on early afterdepolarizations and triggered activity induced by cesium, quinidine, and 4-aminopyridine in canine Purkinje fibers. Am Heart J 118:458–466CrossRefPubMedGoogle Scholar
  5. 5.
    Kleinman ME, Chameides L, Schexnayder SM, Samson RA, Hazinski MF, Atkins DL, Berg MD, de Caen AR, Fink EL, Freid EB, Hickey RW, Marino BS, Nadkarni VM, Proctor LT, Qureshi FA, Sartorelli K, Topjian A, van der Jagt EW, Zaritsky AL (2010) Part 14: pediatric advanced life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 122:S876–S908CrossRefPubMedGoogle Scholar
  6. 6.
    Loughhead AM, Stowe ZN, Newport DJ, Ritchie JC, DeVane CL, Owens MJ (2006) Placental passage of tricyclic antidepressants. Biol Psychiatry 59:287–290CrossRefPubMedGoogle Scholar
  7. 7.
    Reis M, Källén B (2010) Delivery outcome after maternal use of antidepressant drugs in pregnancy: an update using Swedish data. Psychol Med 40:1723–1733CrossRefPubMedGoogle Scholar
  8. 8.
    Schneider U, Haueisen J, Loeff M, Bondarenko N, Schleussner E (2005) Prenatal diagnosis of a long QT syndrome by fetal magnetocardiography in an unshielded bedside environment. Prenat Diagn 25:704–708CrossRefPubMedGoogle Scholar
  9. 9.
    Schwartz PJ, Stramba-Badiale M, Crotti L, Pedrazzini M, Besana A, Bosi G, Gabbarini F, Goulene K, Insolia R, Mannarino S, Mosca F, Nespoli L, Rimini A, Rosati E, Salice P, Spazzolini C (2009) Prevalence of the long-QT syndrome. Circulation 120:1761–1767CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Schwartz PJ, Stramba-Badiale M, Segantini A, Austoni P, Bosi G, Giorgetti R, Grancini F, Marni ED, Perticone F, Rosti D, Salice P (1998) Prolongation of the QT interval and the sudden infant death syndrome. N Eng J Med 338:1709–1714CrossRefGoogle Scholar
  11. 11.
    Syme MR, Paxton JW, Keelan JA (2004) Drug transfer and metabolism by the human placenta. Clin Pharmacokinet 43(8):487–514CrossRefPubMedGoogle Scholar
  12. 12.
    ter Horst PG, Linde S, Smit JP, den Boon J, van Lingen RA, Jansman FG, De Jong-van den Berg LT, Wilffert B (2011) Clomipramine concentration and withdrawal symptoms in 10 neonates. Br J Clin Pharmacol 73(2):295–302CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Naoya Fukushima
    • 1
  • Kenji Nanao
    • 2
  • Hiroyuki Fukushima
    • 3
  • Akira Namera
    • 4
  • Masaru Miura
    • 1
    Email author
  1. 1.Department of CardiologyTokyo Metropolitan Children’s Medical CenterFuchu-shiJapan
  2. 2.Department of PediatricsHino Municipal HospitalHino-shiJapan
  3. 3.Department of PediatricsKeio University HospitalShinjunku-kuJapan
  4. 4.Department of Forensic Medicine, Institute of Biomedical and Health SciencesHiroshima UniversityMinami-kuJapan

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