Increased prevalence of ECG markers for sudden cardiac arrest in refractory epilepsy.
Increased prevalence of ECG markers for sudden cardiac arrest in refractory epilepsy.
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DOI：
10.1136/jnnp-2014-307772
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发表时间：
2015-03
期刊：
影响因子：
--
通讯作者：
Thijs RD
中科院分区：
文献类型：
--
作者：
Lamberts RJ;Blom MT;Novy J;Belluzzo M;Seldenrijk A;Penninx BW;Sander JW;Tan HL;Thijs RD
一项基于社区的研究表明，由于心电图证实的室性心动过速/心室颤动，癫痫患者发生心脏骤停（SCA）的风险增加。我们的目的是确定SCA的ECG风险标志物是否在癫痫患者中更普遍。在一项横断面回顾性研究中，我们分析了185名难治性癫痫患者和178名无癫痫对照者的心电图记录。收集癫痫特征、心脏合并症和药物使用的数据，并评估一般ECG变量（心率（HR）、PQ和QRS间期）。我们分析了三种SCA风险标志物的ECG：严重QTc延长（男性>450 ms，女性>470 ms），Brugada ECG模式和早期复极模式（ERP）。 多元回归模型用于分析组间差异，并确定相关的临床和癫痫相关特征。癫痫患者的HR更高（71 vs 62 bpm，p<0.001），PQ间期更长（162.8 vs 152.6 ms，p=0.001）。 重度QTc间期延长和ERP在癫痫患者中更常见（QTc间期延长：5% vs 0%; p=0.002; ERP：34% vs 13%，p<0.001），而Brugada ECG模式在两组中同样常见（2% vs 1%，p>0.999）。校正协变量后，癫痫仍与ERP（ORadj 2.4，95% CI 1.1 - 5.5）和重度QTc延长（ORadj 9.9，95% CI 1.1 - 1317.7）相关。ERP和严重的QTc间期延长似乎在难治性癫痫患者中更为普遍。未来的研究必须确定这是否有助于增加癫痫患者的SCA风险。
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. 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. 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). 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.
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