Incidence of Malignant Arrhythmias Requiring Hospitalization After Starting Donepezil: A Retrospective Cohort Analysis
By
Yichang Huang
John-Michael Gamble
David N. Juurlink
Mhd. Wasem Alsabbagh
July 1, 2026
Clinical Scorecard: Incidence of Malignant Arrhythmias Requiring Hospitalization After Starting Donepezil: A Retrospective Cohort Analysis
At a Glance
Category Detail
Condition Malignant Arrhythmias Key Mechanisms Inhibition of cardiac delayed rectifier potassium current (IKr) and reduced expression of IKr channel proteins. Target Population Individuals aged 66 and over with Alzheimer's disease (AD) receiving AChEIs. Care Setting Population-based healthcare databases in Canada.
Key Highlights
Donepezil is associated with a greater risk of acquired long-QT syndrome (aLQTS) compared to other AChEIs. Malignant arrhythmias and Alzheimer's disease share common risk factors such as advanced age and female sex. The study utilized linked healthcare databases to analyze hospitalization data. Guideline-Based Recommendations
Diagnosis
Hospitalization for malignant arrhythmias should be monitored in patients starting donepezil. Management
Consider alternative AChEIs for patients at higher risk of arrhythmias. Monitoring & Follow-up
Regular cardiac monitoring may be warranted for patients on donepezil. Risks
Increased risk of malignant arrhythmias associated with donepezil use. Patient & Prescribing Data
Older adults aged 66 and over with newly dispensed AChEIs.
Donepezil is the most widely used AChEI in Canada despite potential cardiac risks.
Clinical Best Practices
Assess cardiac history before prescribing donepezil. Educate patients about potential arrhythmia symptoms. Related Resources & Content
