title: Polytherapy with sodium channel-blocking antiepileptic drugs is associated with arrhythmogenic ST-T abnormality in patients with epilepsy.
abstract: OBJECTIVE
  Recent reports have documented the appearance of Brugada-type ST elevation in cases of overdose of antiepileptic drugs (AEDs). However, little is known about changes on electrocardiographs (ECGs) during AED use at therapeutic doses. AEDs may cause Brugada-type ST elevation or J-wave-like intraventricular conduction delays through an ion channel-blocking effect. In the present study, we sought to elucidate ECG abnormalities in patients on AED therapy.
  
  
  METHODS
  The study population consisted of 120 consecutive patients with epilepsy who continued to take AEDs and had ECGs recorded during these therapies. Their clinical background and ECGs were retrospectively analyzed. Brugada-type ST elevation was classified according to the consensus report on Brugada syndrome. A J-wave-like ECG abnormality was defined as the appearance of notching or slurring of the QRS complex (>0.1mV) in the inferior/lateral leads.
  
  
  RESULTS
  Of the 120 patients, 15 (12.5%) exhibited Brugada-type ST elevation and 35 (29.2%) showed a J-wave-like ECG abnormality. Polytherapy with sodium channel-blocking AEDs (e.g., carbamazepine, phenytoin, lamotrigine) was more frequently observed in patients with Brugada-type ST elevation (p=0.048). However, the serum concentrations of these medicines did not differ between patients with and without ECG abnormalities (carbamazepine: 7.9±4.1 vs. 7.2±5.9μg/dL; phenytoin: 12.7±4.1 vs. 15.5±9.5μg/dL, NS).
  
  
  CONCLUSIONS
  ST-T abnormalities were frequently seen in patients using AEDs. The presence of Brugada-type ST elevation was associated with polytherapy with sodium channel-blocking AEDs.
authors.affiliation: Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan. Electronic address: n_ishizue@med.kitasato-u.ac.jp.
authors.forename: Naruya
authors.initials: N
authors.lastname: Ishizue
authors.affiliation: Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Niwano
authors.affiliation: Department of Psychiatry, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Saito
authors.affiliation: Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Hidehira
authors.initials: H
authors.lastname: Fukaya
authors.affiliation: Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Nakamura
authors.affiliation: Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Tazuru
authors.initials: T
authors.lastname: Igarashi
authors.affiliation: Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Tamami
authors.initials: T
authors.lastname: Fujiishi
authors.affiliation: Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Yoshizawa
authors.affiliation: Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Oikawa
authors.affiliation: Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Satoh
authors.affiliation: Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Kishihara
authors.affiliation: Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Masami
authors.initials: M
authors.lastname: Murakami
authors.affiliation: Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Hiroe
authors.initials: H
authors.lastname: Niwano
authors.affiliation: Department of Psychiatry, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Miyaoka
authors.affiliation: Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Ako
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000009:adverse effects*; D001145:Arrhythmias, Cardiac / Q000139:chemically induced* / Q000503:physiopathology*; D053840:Brugada Syndrome / Q000139:chemically induced; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D004827:Epilepsy / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D026941:Sodium Channel Blockers / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D026941:Sodium Channel Blockers
keywords: Antiepileptic drugs; Brugada syndrome; ECG abnormality; Early repolarization; Epilepsy; J-wave syndrome; Sudden cardiac death