Interictal 12-lead electrocardiography in patients with epilepsy

Area of Science:

• Cardiology
• Neurology
• Epileptology

Background:

• Predictors of sudden unexpected death in epilepsy (SUDEP) on interictal electrocardiograms (EKGs) are not well understood.
• Identifying specific EKG characteristics in epilepsy patients is crucial for risk stratification and potentially preventing SUDEP.

Purpose of the Study:

• To identify unique features of the interictal 12-lead EKG in patients with epileptic seizures compared to nonepileptic seizures (NESs).
• To explore potential correlations between EKG findings, epilepsy type, sex, antiepileptic drugs (AEDs), and SUDEP risk.

Main Methods:

• Retrospective chart review of 195 adult patients (age < 65) admitted to an epilepsy monitoring unit.
• Classification of patients into NESs (control), probable epilepsy (PE), or definite epilepsy (DE) using EEG telemetry.
• Analysis of 12-lead EKGs, focusing on PR interval, QTc interval, and QRS axis, with subgroup analyses.

Main Results:

• Patients with definite localization-related epilepsy showed significantly longer average PR intervals (162.1 ms) than controls (148.8 ms), particularly in females.
• A significant leftward shift in the mean QRS axis was observed in patients with localization-related epilepsy (35.6°) and in female patients with DE (42.1°).
• Levetiracetam use was associated with longer PR and QTc intervals; AED polytherapy correlated with lower QTc intervals.

Conclusions:

• Interictal EKG in epilepsy reveals distinct patterns, including prolonged PR intervals and leftward QRS axis shifts, especially in localization-related epilepsy.
• These EKG signatures may indicate underlying cardiac structural changes or autonomic dysfunction, warranting further investigation for SUDEP prediction.
• Longer-term prospective studies are needed to confirm the predictive value of these electrocardiographic findings for SUDEP.