[Peri-ictal electrocardiographic alterations in paediatric epilepsy patients. A prospective study]
K Ramírez1, P Frangini1, T Mesa1
1Pontificia Universidad Católica de Chile, Santiago de Chile, Chile.
Insights
This study found no serious heart rhythm disorders in children with epilepsy during video-electroencephalogram (video-EEG) monitoring. However, incomplete right bundle branch block was common, especially in refractory epilepsy cases.
Area of Science:
- Pediatric Neurology
- Clinical Cardiology
- Epileptology
Background:
- Epileptic seizures can trigger heart rhythm disturbances and sudden unexpected death in epilepsy (SUDEP).
- Paediatric populations have been underrepresented in studies investigating these peri-ictal cardiac events.
Purpose of the Study:
- To investigate the occurrence of heart rhythm disorders in paediatric patients diagnosed with epilepsy.
- To correlate cardiac findings with epilepsy characteristics using simultaneous video-electroencephalogram (video-EEG) and Holter monitoring.
Main Methods:
- A prospective, observational study involving paediatric patients (<18 years) undergoing video-EEG.
- Simultaneous Holter electrocardiogram (ECG) monitoring was performed alongside neurological and cardiological evaluations.
- Data collected included 768 hours of video-EEG and 281 recorded seizures across 15 patients.
Main Results:
- No severe arrhythmias or SUDEP were observed in the 25 patients studied.
- The most frequent finding was incomplete right bundle branch block (11 patients), more prevalent in refractory epilepsies (p<0.036).
- Heart rate variations were noted primarily during seizures exceeding 30 seconds.
Conclusions:
- This pioneering prospective study, utilizing simultaneous video-EEG and Holter ECG in paediatrics, found no serious cardiac arrhythmias.
- While incomplete right bundle branch block is generally benign, its high prevalence in paediatric epilepsy, particularly refractory forms, warrants further investigation.
- The findings underscore the need for continued research into potential preventive strategies for cardiac events in children with epilepsy.
Introduction:
Epileptic seizures can be associated with peri-ictal heart rhythm disorders and even sudden death (SUDEP). Few paediatric studies have been conducted on the subject.
Aim:
To determine heart rhythm disorders in paediatric patients with epilepsy who were studied with video-electroencephalogram (video-EEG).
Methods:
Prospective, observational study in patients under 18 years of age admitted for video-EEG at the Hospital Clinico Red de Salud UC-Christus, Santiago, Chile. A neurological and cardiological evaluation and electrocardiogram (ECG) were performed, in addition to a Holter ECG simultaneously with the video-EEG.
Results:
Twenty-five patients were studied, 12 with refractory epilepsies, 23/25 focal and 20 on polytherapy. Altogether 768 hours of video-EEG were recorded, including 281 seizures in 15 patients: 157 clinical and 103 generalised. There were no serious arrhythmias, only non-specific or probably benign disorders, mainly incomplete right bundle branch block in 11 patients, which were more frequent in refractory epilepsies (p<0.036). Heart rate variation occurred mainly in seizures >30 seconds. No patient presented SUDEP.
Conclusions:
This is the first prospective study, with a new technique, using video-EEG and Holter ECG simultaneously in paediatrics. Despite the high number of seizures and refractory patients, we found no serious heart rhythm disorders, consistent with the clinical evaluation. Right bundle branch block is considered a non-pathological cardiological finding, but was highly prevalent in our sample compared to the normal population, especially in refractory epilepsy. Given that this is a serious event in epilepsy, it is important to further investigate such studies to assess preventive measures.
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