In recent years, fentanyl, a synthetic opioid that is 50 to 100 times stronger than morphine, has been a main contributor to the opioid crisis. One of the worst adverse effects of fentanyl abuse is opioid-induced cardiac arrest. Although it is well known that opioid abuse can induce arrhythmias; the effects of fentanyl abuse on heart rhythms have not yet been thoroughly investigated.
In a recent study published in Circulation , first-author Gema Mondéjar-Parreño, PhD and senior author Joseph C. Wu, MD, PhD , director of Stanford Cardiovascular Institute, found that human induced pluripotent stem cells provide an unparalleled opportunity to study patient-specific response to opioid abuse. The investigators studied the consequences of fentanyl abuse, specifically those relating to the electrical activity of the heart that determine how the heart controls its rhythm and pumping. The scientists analyzed 19 toxicology studies between 1994 and 2022 in which the mean estimate of fentanyl concentration was three times higher than patients with chronic pain. Using the data, the investigators exposed human induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) to doses of fentanyl that mimicked circumstances of overdose. They found that this caused changes in calcium signaling homeostasis in heart muscle cells and slowed down preparation for the next heartbeat that contributed to beating irregularities. Additionally, since arrhythmias are often more evident when the heart rate increases, the researchers found the combination of fentanyl and isoproterenol, a stimulant used to increase heart rate, can worsen fentanyl-induced arrhythmias.
This study offers groundbreaking evidence that fentanyl abuse can impair the function of cardiac cells, leading to rhythm defects. Together with respiratory depression, fentanyl-induced effects on electrophysiology significantly contribute to cardiac arrest. Further studies will help us better understand fentanyl abuse and its relationship to arrhythmias.
Additional authors include Shane Rui Zhao, Xu Cao, Yu Liu, Johnson Y. Yang, James Jahng, David Wu, and Nazish Sayed from the Stanford Cardiovascular Institute; José Jalife from Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; and Jeremy Leitz from Greenstone Biosciences.
This project was supported by Leducq Foundation Grant 18CVD05, Gootter-Jensen Foundation, and National Institutes of Health (NIH) R01 HL130020, R01 HL145676, R01 HL146690, R01 HL163680, and R01 HL176822 (JCW); R01 HL158641 and R01 HL161002 (NS); R01 HL163943 and PI20/01220 Instituto de Salud Carlos III (JJ); and American Heart Association Postdoctoral Award #872244 (GMP).
