title: Increased prevalence of ECG markers for sudden cardiac arrest in refractory epilepsy.
abstract: OBJECTIVE
  People with epilepsy are at increased risk of sudden cardiac arrest (SCA) due to ECG-confirmed ventricular tachycardia/fibrillation, as seen in a community-based study. We aimed to determine whether ECG-risk markers of SCA are more prevalent in people with epilepsy.
  
  
  METHODS
  In a cross-sectional, retrospective study, we analysed the ECG recordings of 185 people with refractory epilepsy and 178 controls without epilepsy. Data on epilepsy characteristics, cardiac comorbidity, and drug use were collected, and general ECG variables (heart rate (HR), PQ and QRS intervals) assessed. We analysed ECGs for three markers of SCA risk: severe QTc prolongation (male >450 ms, female >470 ms), Brugada ECG pattern, and early repolarisation pattern (ERP). Multivariate regression models were used to analyse differences between groups, and to identify associated clinical and epilepsy-related characteristics.
  
  
  RESULTS
  People with epilepsy had higher HR (71 vs 62 bpm, p<0.001) and a longer PQ interval (162.8 vs 152.6 ms, p=0.001). Severe QTc prolongation and ERP were more prevalent in people with epilepsy (QTc prolongation: 5% vs 0%; p=0.002; ERP: 34% vs 13%, p<0.001), while the Brugada ECG pattern was equally frequent in both groups (2% vs 1%, p>0.999). After adjustment for covariates, epilepsy remained associated with ERP (ORadj 2.4, 95% CI 1.1 to 5.5) and severe QTc prolongation (ORadj 9.9, 95% CI 1.1 to 1317.7).
  
  
  CONCLUSIONS
  ERP and severe QTc prolongation appear to be more prevalent in people with refractory epilepsy. Future studies must determine whether this contributes to increased SCA risk in people with epilepsy.
authors.affiliation: Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.
authors.forename: R J
authors.initials: RJ
authors.lastname: Lamberts
authors.affiliation: Department of Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: M T
authors.initials: MT
authors.lastname: Blom
authors.affiliation: NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London and Epilepsy Society, Chalfont St Peter, UK.
authors.forename: J
authors.initials: J
authors.lastname: Novy
authors.affiliation: NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London and Epilepsy Society, Chalfont St Peter, UK Neurology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Trieste, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Belluzzo
authors.affiliation: Department of Psychiatry, EMGO Institute for Health and Care Research and Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Seldenrijk
authors.affiliation: Department of Psychiatry, EMGO Institute for Health and Care Research and Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: B W
authors.initials: BW
authors.lastname: Penninx
authors.affiliation: Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London and Epilepsy Society, Chalfont St Peter, UK.
authors.forename: J W
authors.initials: JW
authors.lastname: Sander
authors.affiliation: Department of Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: H L
authors.initials: HL
authors.lastname: Tan
authors.affiliation: Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London and Epilepsy Society, Chalfont St Peter, UK LUMC Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: R D
authors.initials: RD
authors.lastname: Thijs
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D015415:Biomarkers; D002423:Cause of Death; D003430:Cross-Sectional Studies; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D004351:Drug Resistance; D004562:Electrocardiography; D004827:Epilepsy / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006339:Heart Rate; D006801:Humans; D008133:Long QT Syndrome / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012307:Risk Factors; D012815:Signal Processing, Computer-Assisted; D013223:Statistics as Topic; D017180:Tachycardia, Ventricular / Q000188:drug therapy / Q000453:epidemiology; D014693:Ventricular Fibrillation / Q000188:drug therapy / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D015415:Biomarkers
keywords: Anticonvulsants; Channels; Epilepsy; Sudden Death