Incidence of Malignant Arrhythmias Requiring Hospitalization After Starting Donepezil: A Retrospective Cohort Analysis
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By
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Yichang Huang
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John-Michael Gamble
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David N. Juurlink
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Mhd. Wasem Alsabbagh
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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.
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