Electrocardiographic Abnormalities and Mortality in Epilepsy Patients

Abstract

Background and Objectives: People with epilepsy (PWE) have a 2–3 times higher mortality rate than the general population. Sudden unexpected death in epilepsy (SUDEP) comprises a significant proportion of premature deaths, whereas sudden cardiac death (SCD) is among the leading causes of sudden death in the general population. Cardiac pathologies are significantly more prevalent in PWE. Whether electrocardiographic (ECG) parameters are associated with remote death in PWE has yet to be elucidated. The study objective was to assess whether interictal ECG parameters are associated with mortality in the long-term. Materials and Methods: The study involved 471 epilepsy patients who were hospitalized after a bilateral tonic-clonic seizure(s). ECG parameters were obtained on the day of hospitalization (heart rate, PQ interval, QRS complex, QT interval, heart rate corrected QT interval (QTc), ST segment and T wave changes), as well as reported ECG abnormalities. Mortality data were obtained from the Latvian National Cause-of-Death database 3–11, mean 7.0 years after hospitalization. The association between the ECG parameters and the long-term clinical outcome were examined. Results: At the time of assessment, 75.4% of patients were alive and 24.6% were deceased. Short QTc interval (odds ratio (OR) 4.780; 95% confidence interval (CI) 1.668–13.698; p = 0.004) was associated with a remote death. After the exclusion of known comorbidities with high mortality rates, short QTc (OR 4.631) and ECG signs of left ventricular hypertrophy (OR 5.009) were associated with a remote death. Conclusions: The association between routine 12-lead rest ECG parameters—short QTc interval and a pattern of left ventricular hypertrophy—and remote death in epilepsy patients was found. To the best of our knowledge, this is the first study to associate rest ECG parameters with remote death in an epileptic population.

Electrocardiogram Abnormalities and Associated Factors Among People with and without Epilepsy Attending the Outpatient Department at Referral Hospitals in Amhara Regional State, Northern Ethiopia, 2022: Institutional-Based Comparative Cross-Sectional Study

“… 8 The prevalence of abnormal electrocardiogram (ECG) finding in epileptic patients in the Caucasian population is 31.8%. 9 In India, 9.4% of epileptic patients had abnormal QTc intervals, 10 and in Egypt 51% of temporal lobe epileptic patients had prolonged QTc intervals. 11 Moreover, abnormalities in ECG among epileptic patients is associated with a higher risk of death.…”

“… 11 Moreover, abnormalities in ECG among epileptic patients is associated with a higher risk of death. 10 …”

Comparing Ictal Cardiac Autonomic Changes in Patients with Frontal Lobe Epilepsy and Temporal Lobe Epilepsy by Ultra-Short-Term Heart Rate Variability Analysis

“…Ictal asystole is a more infrequent symptom that was observed in 0.27% of 6825 patients who underwent video-EEG monitoring [ 19 ]. Excessive activation of the sympathetic nervous system due to intense seizures possibly contributes to cardiopulmonary dysfunction [ 20 , 21 ] and prolonged suppression of brain activity [ 22 ], which can cause impaired arousal independent of the functions of the heart. These intense seizures that are characteristic of epilepsy can cause compensative responses (e.g., elevated adenosine levels) that can eventually result in SUDEP [ 23 ].…”

Exploring Autonomic Alterations during Seizures in Temporal Lobe Epilepsy: Insights from a Heart-Rate Variability Analysis

“…Although the specific pathophysiological mechanism is not clear, some studies imply that most cases of SUDEP are due to postictal central respiratory dysfunction, which eventually causes cardiac arrest [ 16 , 22 , 23 ]. Because SUDEP represents a major cause of premature deaths in patients with epilepsy, an understanding of the effect of seizures on cardiovascular functions is needed [ 24 ].…”