Abnormal Cardiac Repolarization After Seizure Episodes in Structural Brain Diseases: Cardiac Manifestation of Electrical Remodeling in the Brain?
Abnormal Cardiac Repolarization After Seizure Episodes in Structural Brain Diseases: Cardiac Manifestation of Electrical Remodeling in the Brain?
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结构性脑疾病癫痫发作后心脏复极异常：大脑电重塑的心脏表现？
DOI：
10.1161/jaha.120.019778
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发表时间：
2021-05-04
影响因子：
5.4
通讯作者：
Ai T
中科院分区：
文献类型：
--
作者：
Mori S;Hori A;Turker I;Inaji M;Bello-Pardo E;Miida T;Otomo Y;Ai T
在癫痫患者中观察到心脏复极异常，并可能与猝死有关。我们调查了癫痫或癫痫患者的脑结构异常是否与心脏复极异常相关。我们对有和没有脑结构异常的患者癫痫发作后的12导联心电图参数进行了回顾性分析和比较。共纳入96例患者：33名女性(17名有脑异常，16名无脑异常)和63名男性(44名有脑异常，19名无脑异常)。脑部异常包括既往中风、慢性血肿、远端出血、肿瘤、创伤和手术后状态。两组间的心率、PR间期和QRS间期的心电图参数具有可比性。有脑异常者校正QT间期明显延长(女性：Fridericia[正常与异常]，397.4±32.7vs 470.9±48.9；P=0.002；Framingham，351.0±40.1vs 406.2±46.1；P=0.002；Bazett，423.8±38.3vs 507.7±56.6；P<；0.0001；男性Fridericia，403.8±30.4vs 471.0±47.1P<；0.0001；Framingham，342.7±36.4vs 409.4±45.8；P<；0.0001；Bazett，439.3±38.6vs.506.2±56.8P<；0.0001)。两组间QT离散度和T峰−Tend间期无差异。我们还观察到5例ST段异常抬高。重要的是，没有患者在癫痫发作期间或之后出现致命的心律失常。我们的研究表明，脑异常可能与癫痫发作后心脏复极异常有关，这可能是脑电生理学重塑的一种表现。
Abnormal cardiac repolarization is observed in patients with epilepsy and can be associated with sudden death. We investigated whether structural brain abnormalities are correlated with abnormal cardiac repolarizations in patients with seizure or epilepsy. We retrospectively analyzed and compared 12‐lead ECG parameters following seizures between patients with and without structural brain abnormalities. A total of 96 patients were included: 33 women (17 with and 16 without brain abnormality) and 63 men (44 with and 19 without brain abnormality). Brain abnormalities included past stroke, chronic hematoma, remote bleeding, tumor, trauma, and postsurgical state. ECG parameters were comparable for heart rate, PR interval, and QRS duration between groups. In contrast, corrected QT intervals evaluated by Fridericia, Framingham, and Bazett formulas were prolonged in patients with brain abnormality compared with those without (women: Fridericia [normal versus abnormal], 397.4±32.7 versus 470.9±48.9; P=0.002; Framingham, 351.0±40.1 versus 406.2±46.1; P=0.002; Bazett, 423.8±38.3 versus 507.7±56.6; P<0.0001; men: Fridericia, 403.8±30.4 versus 471.0±47.1; P<0.0001; Framingham, 342.7±36.4 versus 409.4±45.8; P<0.0001; Bazett, 439.3±38.6 versus 506.2±56.8; P<0.0001). QT dispersion and Tpeak−Tend intervals were comparable between groups. We also observed abnormal ST‐segment elevation in 5 patients. Importantly, no patients showed fatal arrhythmias during or after seizures. Our study demonstrated that brain abnormalities can be associated with abnormal cardiac repolarization after seizures, which might be a manifestation of electrophysiological remodeling in the brain.