Cardiac arrhythmias and sudden unexpected death in epilepsy: Results of long-term monitoring

Serdyuk, S. E.; Davtyan, K. V.; Бурд, С. Г.; Drapkina, О. М.; Boytsov, S. А.; Gusev, E I; Topchyan, Arpi H

doi:10.1016/j.hrthm.2020.09.002

Cited by 30 publications

(16 citation statements)

References 18 publications

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“…This is comparable to a recent prospective study of 193 participants with drug-resistant focal epilepsy who underwent monitoring with an implantable subcutaneous loop recorder (median duration 36 months), which found that 3 (1.6%) patients had periods of asystole >6 seconds and underwent subsequent pacemaker insertion. 13 Overall these estimates are much higher than patients monitored in video-EEG monitoring units, which report that up to 0.4% of patients have significant periods of bradycardia or asystole. 20,21 In our study, bradycardic or asystolic events that were not associated with seizures were likely physiologic and in response to enhanced vagal tone during sleep.…”

Section: Discussionmentioning

confidence: 86%

Serious Cardiac Arrhythmias Detected by Subcutaneous Long-term Cardiac Monitors in Patients With Drug-Resistant Epilepsy

et al. 2022

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Background:Epilepsy is associated with an increased risk of cardiovascular disease and premature mortality, including sudden unexpected death in epilepsy (SUDEP). Of concern, serious cardiac arrythmias might go undetected from routine epilepsy and cardiac investigations.Methods:This prospective cohort study aimed to detect cardiac arrhythmias in patients with chronic drug-resistant epilepsy (≥5 years duration) using subcutaneous cardiac monitors for a minimum follow-up duration of 12 months. Participants with known cardiovascular disease or those with abnormal 12-lead electrocardiograms were excluded. The device was programmed to automatically record episodes of tachycardia ≥140 beats per minute (bpm), bradycardia ≤40 bpm for ≥3 seconds, or asystole ≥3 seconds.Findings:Thirty-one patients underwent subcutaneous cardiac monitoring for a median recording duration of 2.2 years (range 0.5 to 4.2). During this time, 28 (90.3%) patients had episodes of sustained (≥30s) sinus tachycardia, 8/31 (25.8%) had sinus bradycardia, and 3 (9.7%) had asystole. Three (9.7%) patients had serious cardiac arrhythmias requiring additional cardiac interventions. Among them, two patients had prolonged sinus arrest and ventricular asystole (>6 seconds), leading to pacemaker insertion in one; and another patient with an epileptic encephalopathy had multiple episodes of recurrent non-sustained polymorphic ventricular tachycardia and bundle branch conduction abnormalities. The time to first detection of a clinically significant cardiac arrhythmia ranged between 1.2 to 26.9 months following cardiac monitor insertion.Conclusions:Implantable cardiac monitors detected a high incidence of clinically significant cardiac arrhythmias in patients with chronic drug resistant epilepsy, which may contribute to the incidence of premature mortality including SUDEP.

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Section: Discussionmentioning

confidence: 86%

Serious Cardiac Arrhythmias Detected by Subcutaneous Long-term Cardiac Monitors in Patients With Drug-Resistant Epilepsy

et al. 2022

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“…The present study showed that regarding ECG types, 88 (88%) patients had normal ECG, 11 (11%) patients had sinus tachycardia and 1 (1%) patient had incomplete right bundle branch block (IRBBB). In contrary, Serdyuk et al (Serdyuk et al, 2021) performed a total of 6494 electrocardiogram traces during the median follow-up of 36 months to evaluate the frequency and type of cardiac arrhythmias in patients with drug-resistant epilepsy and reported that the most common ECG type was ictal sinus tachycardia (66.8%). The discrepant sample size and the resistance to epileptic drugs recorded in Serdyuk et al study may account for the contradictory results.…”

Section: Discussionmentioning

confidence: 99%

Holter study in Epileptic

Ahmed¹,

Marghany²,

Rahhal³

et al. 2022

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Introduction: Heart rate variability have the potential to serve as a biomarker of SUDEP risk, allowing for increased counselling of patients and their families and serving as a valuable outcome measure for research aimed at developing drugs and therapies to reduce SUDEP risk. The sympathetic and parasympathetic modulatory activities of cardiac nerves result in a Holter test lasting less than 24 hours (a few minutes). Objective: for detection of heart rate variability and cardiac arrhythmias in epileptic children. Materials and methods: This cross-sectional study was carried out on 100 children with epilepsy. All patients were subjected to: history taking, full physical examination, echocardiography, 24 hours Holter, EEG, MRI brain, Standard 12-derivation ECG (including V4 R derivation). Results: There was a significant variability in HF, LF, LF/HF, RMSSD, SDNN and PNN50 among all time measurements throughout the day (P values <0.001). Heart rate variability was significantly worse in younger patients aged less than 10 years than others and was found comparable between males and females (P values > 0.05). Heart rate variability was significant in relation to EEG localization (All P<0.001) being worse in case of left temporal localization when compared to other types.

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“…The results of this article have found that the success rate of CPR is higher in patients with de brillating heart rhythm than in patients with non-de brillating heart rhythm, and the initial heart rhythm type is the in uencing factor of CPR success. Studies [24,25] have found that in patients with cardiac arrest in the hospital, if the initial heart rhythm type is a de brillating heart rhythm, their CPR success rate, survival rate after discharge, and neurological recovery at discharge are all improved than those who cannot de brillate, which is in line with the ndings of our study .The reason may be that when the initial heart rhythm is ventricular brillation or ventricular tachycardia, the heart is in a weak and irregular contraction state, and there is weak tissue perfusion in the body, so the effect of CPR is better [20,26].…”

Section: Discussionmentioning

confidence: 99%

Emergency Cardiopulmonary Resuscitation of Out-of Hospital Cardiac Arrest: Why Should we Care

Huang

Chen²,

Yu³

et al. 2021

Preprint

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Background: Cardiopulmonary resuscitation (CPR) plays an essential role in the treatment of sudden cardiac arrest (SCA), we aimed to evaluate the influencing factors on the effects of CPR in patients with SCA, to provide insights into the management of SCA.Methods: Patients who underwent CPR in the emergency department of our hospital from January 1, 2019 to June 30, 2021 were selected. We collected and analyzed the clinical characteristics of CPR patients. Logistic regression analyses were conducted to identify the risk factors of CPR failure.Results: A total of 308 CPR patients were included, the incidence of CPR success was 35.71%. There were significant differences in the age, time to the start of CPR, the type of heart rhythm in the first monitoring, duration of CPR and cumulative adrenaline dosage between CPR success and failure group (all P<0.05). No significant differences in the gender, cause of cardiac arrest and ventilation methods were found (all P>0.05). Logistic regression analyses indicated that age≥65y(OR2.132, 95CI%1.127~4.334), time to the start of CPR≥12min(OR2.503, 95CI%1.015~3.583), unable to defibrillation(OR1.856, 95CI%1.107~3.031), duration of CPR≥40min(OR2.162, 95CI%1.242~4.178), cumulative adrenaline dosage≥6mg(OR1.627, 95CI%1.151~2.472) were the independent risk factors of CPR failure(all P<0.05).Conclusions: The success and failure of CPR are affected by many factors. Early and effective interventions should be taken for these influencing factors in clinical practice. Due to the limitation of sample size, future large-sample and multi-center studies need to further explore the relevant influencing factors of CPR.

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Cardiac arrhythmias and sudden unexpected death in epilepsy: Results of long-term monitoring

Cited by 30 publications

References 18 publications

Serious Cardiac Arrhythmias Detected by Subcutaneous Long-term Cardiac Monitors in Patients With Drug-Resistant Epilepsy

Serious Cardiac Arrhythmias Detected by Subcutaneous Long-term Cardiac Monitors in Patients With Drug-Resistant Epilepsy

Holter study in Epileptic

Emergency Cardiopulmonary Resuscitation of Out-of Hospital Cardiac Arrest: Why Should we Care

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