Severe QTc prolongation and an early repolarization pattern on ECG may be more prevalent in people with refractory epilepsy than in healthy individuals, according to a cross-sectional, retrospective analysis of ECG recordings published online ahead of print June 19 in the Journal of Neurology, Neurosurgery, and Psychiatry.
Severe QTc prolongation was present in 5% of recordings of 185 patients with refractory epilepsy, compared with none of the recordings of 178 controls without epilepsy. An early repolarization pattern (ERP) was present in 34% of recordings of patients vs 13% of recordings of controls.
After adjustment for epilepsy, gender, age, and heart rate, epilepsy remained associated with severe QTc prolongation (odds ratio [OR], 9.9), and ERP (OR, 2.4), said Robert J. Lamberts, MD, a doctoral student at Stichting Epilepsie Instellingen Nederland in Heemstede, the Netherlands.
Recent data show that patients with epilepsy have a two- to threefold increased risk of sudden cardiac arrest (SCA). In addition, severe QTc prolongation and ERP are known markers for SCA risk in the general population. The findings of the retrospective analysis might explain why patients with epilepsy have an increased risk of SCA, said Dr. Lamberts.
“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,” Dr. Lamberts concluded.
—Sharon Worcester