Prognostic impact of misdiagnosis of cardiac channelopathies as epilepsy

Abstract

Introduction Cardiac channelopathies are a frequent cause of sudden cardiac death (SCD) and often manifest with convulsive syncope, leading to a misdiagnosis of epilepsy. We aim to evaluate the clinical impact of epilepsy misdiagnosis in a cohort of patients with cardiac channelopathies. Methods Fifty probands/families with a cardiac channelopathy were included. We retrospectively collected information from medical records to identify all patients who presented with convulsive syncope and were diagnosed with epilepsy after neurological evaluation. Clinical data and outcome were compared with those of patients without a previous epilepsy diagnosis. Results Eight patients had a previous diagnosis of epilepsy. At first episode, 3 of them presented a positive family history of SCD and 5 showed a pathological electrocardiogram; half presented with sudden cardiac arrest (SCA) and the rest with recurrent syncope despite treatment with 1 or more anti-epileptic drugs. Five patients had long QT syndrome, 2 had catecholaminergic polymorphic ventricular tachycardia, and 1 had Brugada syndrome. Epilepsy misdiagnosis was associated with an increased risk of SCA/SCD (OR 6.92, P = .04), a delay of 12 years (P = .047) in correct diagnosis, and a delay from first symptom to channelopathy diagnosis of 18.45 years (P < .0001). Conclusion Cardiac channelopathy patients can be misdiagnosed with epilepsy. This involves a delayed diagnosis, a delay from the first symptom to a correct diagnosis, and an increased risk of SCA/SCD.

High‐risk atrioventricular block in Brugada syndrome patients with a history of syncope

“…Second, this study lacked an age‐matched control group to compare the incidence of AVB with that in BrS patients. However, compared with the incidence of high‐risk AVB detected in a population of individuals with syncope and structurally normal hearts who were followed with ILR, the incidence of high‐risk AVB in our BrS patients was lower 3–5,12 . Continuous monitoring with ILR was not performed in all patients in this study.…”

“…However, arrhythmic syncope can be caused by bradycardia such as atrioventricular block (AVB), which should be managed by cardiac pacing. Despite the fact that high‐risk AVB could be detected in 5%–11% of patients with syncope and structurally normal hearts, 3–5 the clinical characteristics and prevalence of high‐risk AVB in BrS patients with syncope remain unknown. The purpose of this study was to investigate the clinical characteristics of BrS patients with high‐risk AVB.…”

“Resistance Is Futile”: A Pilot Study into Pseudoresistance in Canine Epilepsy

“…Petkar et al, found a high incidence of bradyarrhythmias and asystole in cases where there was uncertainty surrounding the diagnosis of epilepsy [37]. Cardiac channelopathies often manifest with convulsive syncope, leading to a misdiagnosis of epilepsy which puts these patients at risk of developing serious and life-threatening arrhythmias [40]. Differentiation of generalised epileptic seizures and syncope can also be quite challenging in veterinary medicine, since the two syndromes can share a similar clinical manifestation [41,42].…”