title: Epileptic patients who survived sudden cardiac death have increased risk of recurrent arrhythmias and death.
abstract: BACKGROUND
  Cardiac arrhythmogenesis and cryptogenic epilepsy can be due to ion channel dysfunction and may coexist in the same patient. Sudden unexplained death in epilepsy (SUDEP) is a known entity with unknown cause, with the possibility of ventricular tachyarrhythmias being one of the causes. However, no prior study has investigated epileptic survivors of sudden cardiac death (SCD), recurrent life-threatening ventricular tachyarrhythmia (LTVA) and other outcomes in this patient population.
  
  
  METHODS
  The Antiarrhythmics Versus Implantable Cardioverter Defibrillators (AVID) Trial (n = 1016) was a multicenter trial comparing a cardioverter-defibrillator device (ICD) (n = 507) and anti-arrhythmic drugs (AADs) (n = 499) for secondary prevention of LTVAs. Mean follow-up duration was 916 ± 471 days per patient. Patients with a history of epilepsy (n = 6) in the ICD arm were included in this analysis. End points were recurrence of LTVA, cardiac death and all-cause mortality.
  
  
  RESULTS
  History of epilepsy (n = 6) was a significant predictor of recurrent LTVA [hazard ratio 3.53, 95% confidence interval (CI) 1.30-9.56], cardiac death (hazard ratio 4.14, 95% CI 1.30-13.14) and all-cause mortality (hazard ratio 3.82, 95% CI 1.40-10.48) in the ICD arm (n = 498). This relationship remained unchanged on multivariate analysis after controlling for baseline clinical differences.
  
  
  CONCLUSIONS
  This is the first study to investigate the effect of epilepsy on secondary prevention of LTVA. Epileptic survivors of SCD are at significantly greater risk of recurrent arrhythmias and death as compared to other survivors of recurrent LTVA. Role of coexisting channelopathies in both epilepsy and arrhythmogenesis may explain SUDEP and requires further investigation.
authors.affiliation: Division of Cardiology/Electrophysiology, Department of Internal Medicine, Wayne State University, Detroit, Michigan 48201, USA.
authors.forename: Apurva
authors.initials: A
authors.lastname: Badheka
authors.forename: Ankit
authors.initials: A
authors.lastname: Rathod
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Kizilbash
authors.forename: Zongshan
authors.initials: Z
authors.lastname: Lai
authors.forename: Tamam
authors.initials: T
authors.lastname: Mohamad
authors.forename: Aashit
authors.initials: A
authors.lastname: Shah
authors.forename: Luis
authors.initials: L
authors.lastname: Afonso
authors.forename: Sony
authors.initials: S
authors.lastname: Jacob
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000295:instrumentation; D004827:Epilepsy / Q000150:complications* / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D017180:Tachycardia, Ventricular / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents