Severe QTc prolongation and early repolarization pattern on electrocardiogram were more prevalent in people with refractory epilepsy than in controls in a cross-sectional, retrospective analysis of electrocardiogram recordings.
Severe QTc prolongation was present in 5% of recordings from 185 patients with drug-refractory epilepsy, compared with none of those from 178 controls without epilepsy, and early repolarization pattern (ERP) was present in 34% vs. 13% of recordings from the patients and controls, respectively. After adjustment for epilepsy, gender, age, and heart rate, epilepsy remained associated with severe QTc prolongation (odds ratio, 9.9), and ERP (OR, 2.4), reported Dr. Robert J. Lamberts of Stichting Epilepsie Instellingen Nederland, Heemstede, the Netherlands (J. Neurol. Neurosurg. Psychiatry 2014 June 19 [doi:10.1136/jnnp-2014-307772]).
Recent data show that patients with epilepsy are at a two- to threefold increased risk of sudden cardiac arrest (SCA), and severe QTc prolongation and ERP are known markers for SCA risk in the general population. The current findings might explain why patients with epilepsy carry an increased risk of SCA, noted Dr. Lamberts and his colleagues.
"Routine ECG evaluation in people with epilepsy may be of importance in guiding clinicians in their choice of antiepilepsy drug therapy, for example, avoidance of QT-prolonging or depolarization-blocking drugs in people with ECG markers of increased SCA risk," they concluded.
The Dutch Epilepsy Foundation, Christelijke Vereniging voor de Verpleging van Lijders aan Epilepsie, and the Netherlands Organisation for Scientific Research funded the study. Dr. Lamberts had no disclosures. Coauthors disclosed ties with the Epilepsy Society, the Dr. Marvin Weil Epilepsy Research Fund, Eisai, GSK, UCB Pharma, the World Health Organization, the National Institutes of Health, NUTS Ohra Fund, Medtronic, the AC Thomson Foundation, the Swiss National Science Foundation, and the SICPA Foundation.