Abnormal repolarization: A common electrocardiographic finding in patients with epilepsy

Area of Science:

• Cardiology
• Neurology
• Clinical Electrophysiology

Background:

• Early repolarization (ER) on electrocardiograms (ECGs) is increasingly recognized as a potential risk marker for sudden cardiac death.
• The association between specific ER patterns and outcomes in epilepsy patients, particularly sudden unexplained death in epilepsy (SUDEP), remains largely unexplored.

Purpose of the Study:

• To investigate the prevalence and characteristics of abnormal early repolarization (ER) in epilepsy patients compared to controls.
• To determine if ER patterns in epilepsy patients are influenced by antiepileptic drugs or seizure control.
• To explore the potential relationship between abnormal ER and SUDEP in epilepsy patients.

Main Methods:

• Electrocardiograms (ECGs) of 354 epilepsy patients and 140 controls were analyzed for J-peak amplitude and ST-segment morphology.
• Abnormal ER was defined as J-wave amplitude ≥0.1 mV in inferior leads.
• Clinical follow-up data, including SUDEP events, were collected over a median of 7 years.

Main Results:

• Epilepsy patients exhibited a significantly higher prevalence of abnormal ER (19.8%) compared to controls (8.6%) in inferior leads (P=0.002).
• ER with horizontal or descending ST segments was also more common in epilepsy patients (P<0.001).
• Male gender was the sole significant predictor of abnormal ER in epilepsy patients (P=0.03). No significant changes in ER were observed after antiepileptic drug initiation or seizure suppression.

Conclusions:

• Abnormal early repolarization (ER) is more prevalent in epilepsy patients than in the general population.
• ER patterns in epilepsy patients are not significantly affected by antiepileptic drug treatment or seizure control.
• The clinical significance of abnormal ER in relation to SUDEP in epilepsy patients warrants further investigation.