Seizure-related cardiac repolarization abnormalities are associated with ictal hypoxemia.
Seizure-related cardiac repolarization abnormalities are associated with ictal hypoxemia.
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DOI：
10.1111/j.1528-1167.2011.03262.x
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发表时间：
2011-11
期刊：
影响因子：
5.6
通讯作者：
Bateman LM
中科院分区：
文献类型：
--
作者：
Seyal M;Pascual F;Lee CY;Li CS;Bateman LM
心律失常和呼吸紊乱被认为是癫痫猝死的可能原因。在接受住院视频脑电遥测(VET)的定位相关癫痫(LRE)患者中，三分之一的患者会出现氧减饱和，这是他们手术前检查的一部分。发作期相关的氧减饱和伴随高碳酸血症。据报道，癫痫发作时，心电图(EKG)上的校正QT间期(QT间期)异常延长和缩短。QTC异常与心源性猝死风险增加有关。我们假设发作性低氧血症与心脏复极异常之间可能存在关联。对难治性LRE患者的VET资料进行分析。选择至少有一次癫痫发作且伴随氧饱和度低于90%且无伪影的EKG数据的连续患者。分析发作前1min(Pre)和发作/发作后伴随氧饱和度低于90%的EKG(Desat)。连续测量QT间期和RR间期。在相同的患者中，将Desat癫痫与不伴氧减饱和度低于90%的癫痫(NODESAT)进行比较。对于NODESAT发作，测量发作后2分钟的QT间期和RR间期。对17例定位相关癫痫患者的37次Desat发作进行了分析。Pre期间共分析了2448个QT间期和RR间期。在DESAT期间，分析1554QT间期和RR间期。17例患者中有12例至少有一次NODESAT发作。分析了19例NODESAT发作，其中Pre期间有1558个QT间期和RR间期，NODESAT期间有3408个QT和RR间期。在DESAT期间异常延长(>；457ms)QTcH(霍奇斯校正法)相对于之前的赔率比为10.64%(p<；0.0001)。在DESAT期间QTcH异常缩短(<；372ms)的赔率比为1.65(p<；0.0001)。应用Fridericia校正QT时，还观察到与发作相关的QT间期缩短和延长。DISAT发作时QT值(Qtr)的平均范围(61.14毫秒)与发作前(44.43毫秒)相比有显著差异(P=0.01)。Desat qtr与血氧饱和度最低值之间存在显著的相关性(p=0.025)，而Desat qtr与氧减饱和时间之间存在显著的相关性(p<；0.0001)。NODESAT发作时QTcH延长和缩短也可见。与发作相关的QTcH延长在DEAT中比NODESAT中更有可能发生，优势比为4.3(p<；0.0001)。发作相关的QTcH缩短在DEAT比NODESAT更有可能发生，优势比为2.13(p<；0.0001)。我们已经证明，与不伴有氧减饱和的癫痫相比，伴有氧减饱和的癫痫发作的QTcH异常延长的可能性增加4.3倍。QTcH异常缩短的可能性在伴有氧减饱和的癫痫发作中增加，与不伴有氧减饱和的癫痫发作相比，优势比为2.13。氧减饱和的深度和持续时间与QTR值的增加有显著的相关性。这些发现可能与SUDEP的病理生理学有关。
Cardiac arrhythmias and respiratory disturbances have been proposed as likely causes for sudden unexpected death in epilepsy. Oxygen desaturation occurs in one-third of patients with localization-related epilepsy (LRE) undergoing inpatient video-EEG telemetry (VET) as part of their pre-surgical workup. Ictal-related oxygen desaturation is accompanied by hypercapnia. Both abnormal lengthening and shortening of the corrected QT interval (QTc) on the electrocardiogram (EKG) have been reported with seizures. QTc abnormalities are associated with increased risk of sudden cardiac death. We hypothesized that there may be an association between ictal hypoxemia and cardiac repolarization abnormalities. VET data from patients with refractory LRE were analyzed. Consecutive patients having at least one seizure with accompanying oxygen desaturation below 90% and artifact free EKG data were selected. EKG during the one minute prior to seizure onset (PRE) and during the ictal/postictal period with accompanying oxygen desaturation below 90%(DESAT) was analyzed. Consecutive QT and RR intervals were measured. In the same patients, DESAT seizures were compared with seizures without accompanying oxygen desaturation below 90% (NODESAT). For NODESAT seizures, QT and RR intervals for 2 minutes after seizure onset were measured. 37 DESAT seizures were analyzed in 17 patients with localization-related epilepsy. A total of 2448 QT and RR intervals were analyzed during PRE. During DESAT, 1554QT and RR intervals were analyzed. 12 of the 17patients had at least one NODESAT seizure. A total of 19 NODESAT seizures were analyzed, including 1558 QT and RR intervals during PRE and 3408 QT and RR intervals during NODESAT. The odds ratio for an abnormally prolonged (>457 msec) QTcH (Hodges correction method) during DESAT relative to PRE was 10.64(p<0.0001). The odds ratio for an abnormally shortened (<372 msec) QTcH during DESAT relative to PRE was 1.65 (p<0.0001). Seizure-related shortening and prolongation of QTc during DESAT were also observed when Fridericia correction of the QT was applied. During DESAT seizures, the mean range of QT values (QTr)(61.14 msec) was significantly different from that during PRE (44.43 msec) (p=0.01). There was a significant association between DESAT QTr and oxygen saturation nadir (p=0.025) and between DESAT QTr and duration of oxygen desaturation (p < 0.0001). Both QTcH prolongation and shortening also occurred with NODESAT seizures. A seizure-associated prolonged QTcH was more likely during DESAT than NODESAT with an odds-ratio of 4.30 (p<0.0001). A seizure-associated shortened QTcH was more likely during DESAT than NODESAT with an odds-ratio of 2.13 (p<0.0001). We have shown that the likelihood of abnormal QTcH prolongation is increased 4.3-fold with seizures that are associated with oxygen desaturation when compared with seizures that are not accompanied with oxygen desaturation. The likelihood of abnormally shortened QTcH increases with seizures that are accompanied by oxygen desaturation with an odds-ratio of 2.13 compared with that in seizures without desaturations. There is a significant association between the depth and duration of oxygen desaturation and QTr increase. These findings may be related to the pathophysiology of SUDEP.
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影响因子：
3.8
作者：
Kändler, L;Fiedler, A;Schneider, P
通讯作者：
Schneider, P
影响因子：
5.6
作者：
Surges, Rainer;Adjei, Patrick;Walker, Matthew C.
通讯作者：
Walker, Matthew C.
DOI：
10.1111/j.1540-8159.2009.02657.x
发表时间：
2010-05-01
影响因子：
1.8
作者：
Chiladakis, John;Kalogeropoulos, Andreas;Alexopoulos, Dimitrios
通讯作者：
Alexopoulos, Dimitrios
影响因子：
24
作者：
Haigney, MC;Zareba, W;Moss, AJ
通讯作者：
Moss, AJ
影响因子：
2.8
作者：
Roche, F;Reynaud, C;Barthélémy, JC
通讯作者：
Barthélémy, JC