Abstract
OBJECTIVE: To determine the incidence of clinically relevant arrhythmias in refractory focal epilepsy and to assess the potential of postictal arrhythmias as risk markers for sudden unexpected death in epilepsy (SUDEP).
METHODS: We recruited people with refractory focal epilepsy without signs of ictal asystole and who had at least one focal seizure per month and implanted a loop recorder with 2-year follow-up. The devices automatically record arrhythmias. Subjects and caregivers were instructed to make additional peri-ictal recordings. Clinically relevant arrhythmias were defined as asystole ≥ 6 seconds; atrial fibrillation < 55 beats per minute (bpm), or > 200 bpm and duration > 30 seconds; persistent sinus bradycardia < 40 bpm while awake; and second- or third-degree atrioventricular block and ventricular tachycardia/fibrillation. We performed 12-lead electrocardiography (ECG) and tilt table testing to identify non-seizure-related causes of asystole.
RESULTS: We included 49 people and accumulated 1060 months of monitoring. A total of 16 474 seizures were reported, of which 4679 were captured on ECG. No clinically relevant arrhythmias were identified. Three people had a total of 18 short-lasting (<6 seconds) periods of asystole, resulting in an incidence of 2.91 events per 1000 patient-months. None of these coincided with a reported seizure; one was explained by micturition syncope. Other non-clinically relevant arrhythmias included paroxysmal atrial fibrillation (n = 2), supraventricular tachycardia (n = 1), and sinus tachycardia with a right bundle branch block configuration (n = 1).
SIGNIFICANCE: We found no clinically relevant arrhythmias in people with refractory focal epilepsy during long-term follow-up. The absence of postictal arrhythmias does not support the use of loop recorders in people at high SUDEP risk.
| Original language | English |
|---|---|
| Pages (from-to) | 2215-2223 |
| Number of pages | 9 |
| Journal | Epilepsia |
| Volume | 60 |
| Issue number | 11 |
| DOIs | |
| Publication status | Published - 21 Oct 2019 |
Funding
We thank Marijntje Bressers and Ineke Diderich for their help in patient follow‐up and Emiel Bakker and Bettien van Dijk for their help in reviewing all ECG recordings. J.W.S. is based at the National Institute for Health Research University College London Hospitals Comprehensive Biomedical Research Centre, which receives funding from the UK Department of Health's Research Centres funding scheme. He receives research support from the Dr Marvin Weil Epilepsy Research Fund and UK Epilepsy Society. R.D.T. receives research support from the Dutch National Epilepsy Fund (project 15–10); Netherlands Organization for Health Research and Development; Christelijke Vereniging voor de Verpleging van Lijders aan Epilepsie, the Netherlands; and AC Thomson Foundation. M.v.d.L., R.J.L., H.L.T., F.J.d.L., A.J.A., and H.P.S. report no disclosures. J.B.A. reports grants and personal fees from UCB, outside the submitted work. J.W.S. has received research funding from Eisai and UCB, and personal fees from Eisai, UCB, Bial, and Janssen, outside of the submitted work. R.D.T. receives research support from Medtronic and has received fees for lectures from Medtronic, which provided the implantable loop recorders used in this study. R.D.T. has received fees for lectures from UCB Pharma and GlaxoSmithKline, outside the submitted work. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.
Keywords
- cardiac arrhythmias
- ECG
- epilepsy
- implantable loop recorders
- sudden unexpected death in epilepsy