Epilepsy is associated with ventricular alterations following convulsive status epilepticus in children.
Epilepsy is associated with ventricular alterations following convulsive status epilepticus in children.
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DOI：
10.1002/epi4.12074
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发表时间：
2017-12-01
期刊：
影响因子：
3
通讯作者：
Lai, Yi-Chen
中科院分区：
文献类型：
--
作者：
Ali, Wail;Bubolz, Beth A;Lai, Yi-Chen
目的：惊厥性癫痫持续状态可对成人产生深远的心血管影响，包括心室除极-复极异常。癫痫持续状态是否对儿童心室电特性产生不利影响尚不清楚。因此，我们试图描述惊厥性癫痫持续状态儿童的心室改变和相关临床因素。方法：我们进行了一项为期 2 年的回顾性病例对照研究。如果 1 个月至 21 岁之间的儿童被纳入儿科重症监护病房，初步诊断为惊厥性癫痫持续状态，并在入院 24 小时内进行 12 导联心电图 (ECG)，则被纳入其中。患有心脏病、离子通道病或正在服用血管活性药物的儿童被排除在外。年龄匹配的对照受试者没有癫痫发作或癫痫病史。主要结局是心室异常，表现为 ST 段变化、T 波异常、QRS 轴偏差和校正 QT (QTc) 间期延长。次要结局包括 QT/RR 关系、逐次 QTc 间期变异性、组间心电图间期测量以及与心电图异常相关的临床因素。 结果：在 317 名符合条件的儿童中，59 名符合纳入标准。 31 名儿童（癫痫）有癫痫病史，28 名儿童（非癫痫）无癫痫病史。与对照组（n = 31）相比，癫痫持续状态组更容易出现心电图异常，非癫痫组和癫痫组的总体比值比分别为 3.8 和 7.0。简单线性回归分析表明，癫痫儿童表现出 QT 间期对心率的依赖性和适应性受损。癫痫儿童的逐搏 QTc 间期变异性（心室复极不稳定的标志）增加。意义：惊厥性癫痫持续状态会对儿童（尤其是癫痫儿童）的心室电特性和稳定性产生不利影响。这些发现表明，患有癫痫的儿童可能特别容易出现癫痫引起的心律失常。因此，该人群可能需要进行发作后心脏监测。
OBJECTIVE: Convulsive status epilepticus can exert profound cardiovascular effects in adults including ventricular depolarization-repolarization abnormalities. Whether status epilepticus adversely affects ventricular electrical properties in children is less understood. Therefore, we sought to characterize ventricular alterations and the associated clinical factors in children following convulsive status epilepticus.METHODS: We conducted a 2-year retrospective, case-control study. Children between 1 month and 21 years of age were included if they were admitted to the pediatric intensive care unit with primary diagnosis of convulsive status epilepticus and had 12-lead electrocardiogram (ECG) within 24 hours of admission. Children with heart disease, ion channelopathy, or on vasoactive medications were excluded. Age-matched control subjects had no history of seizures or epilepsy. The primary outcome was ventricular abnormalities represented by ST segment changes, abnormal T wave, QRS axis deviation, and corrected QT (QTc) interval prolongation. The secondary outcomes included QT/RR relationship, beat-to-beat QTc interval variability, ECG interval measurement between groups, and clinical factors associated with ECG abnormalities.RESULTS: Of 317 eligible children, 59 met the inclusion criteria. History of epilepsy was present in 31 children (epileptic) and absent in 28 children (non-epileptic). Compared with the control subjects (n = 31), the status epilepticus groups were more likely to have an abnormal ECG with overall odds ratio of 3.8 and 7.0 for the non-epileptic and the epileptic groups respectively. Simple linear regression analysis demonstrated that children with epilepsy exhibited impaired dependence and adaptation of the QT interval on heart rate. Beat-to-beat QTc interval variability, a marker of ventricular repolarization instability, was increased in children with epilepsy.SIGNIFICANCE: Convulsive status epilepticus can adversely affect ventricular electrical properties and stability in children, especially those with epilepsy. These findings suggest that children with epilepsy may be particularly vulnerable to seizure-induced arrhythmias. Therefore postictal cardiac surveillance may be warranted in this population.