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Associations between epilepsy, respiratory impairment, and minor ECG abnormalities in children
See Wai Chan1, Angela Chun2, Linh Nguyen3
1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
Insights
Children with epilepsy experiencing seizures show more minor ECG abnormalities, especially with respiratory distress. Increased respiratory support is linked to these cardiac changes in children with epilepsy.
Area of Science:
- Pediatric Cardiology
- Neurology
- Critical Care Medicine
Background:
- Electrocardiogram (ECG) abnormalities can occur during acute seizures.
- Respiratory derangements are common during seizures and may impact cardiac function.
Purpose of the Study:
- To investigate the effects of acute seizures and respiratory issues on cardiac electrical properties in children.
- To analyze the interaction between these factors and a diagnosis of epilepsy.
Main Methods:
- Retrospective review of emergency center visits for seizures or epilepsy (1/2011-12/2013).
- Included children with ECGs within 24 hours, excluding those with pre-existing cardiac conditions.
- 1:1 age and gender matching for control subjects.
- Multivariable logistic regression identified associations between clinical factors and abnormal ECGs.
Main Results:
- Children with epilepsy had a higher prevalence of minor ECG abnormalities (49%) compared to controls (29%) and non-epilepsy seizure patients (36%).
- Epilepsy, need for supplemental oxygen, and mechanical ventilation were independently associated with minor ECG abnormalities.
- Respiratory support level showed an independent association with ECG abnormalities specifically in the epilepsy group.
Conclusions:
- Increased respiratory support is independently associated with minor ECG abnormalities in children with epilepsy.
- This suggests a potential influence of respiratory status on cardiac electrical activity in pediatric epilepsy patients.
Objective:
We sought to examine the effects of acute seizures and respiratory derangement on the cardiac electrical properties reflected on the electrocardiogram (ECG); and to analyze their potential interactions with a diagnosis of epilepsy in children.
Methods:
Emergency center (EC) visits with seizure or epilepsy diagnostic codes from 1/2011-12/2013 were included if they had ECG within 24 h of EC visit. Patients were excluded if they had pre-existing cardiac conditions, ion channelopathy, or were taking specific cardiac medications. Control subjects were 1:1 age and gender matched. Abnormal ECG was defined as changes in rhythm, PR, QRS, or corrected QT intervals; QRS axis or morphology; ST segment; or T wave morphology from normal standards. We identified independent associations between clinical factors and abnormal ECG findings using multivariable logistic regression modeling.
Results:
Ninety-five children with epilepsy presented to the EC with seizures, respiratory distress, and other concerns. Three hundred children without epilepsy presented with seizures. There was an increased prevalence of minor ECG abnormalities in children with epilepsy (49 %) compared to the control subjects (29 %) and those without epilepsy (36 %). Epilepsy (OR: 1.61, 95 %CI: 1.01-2.6), need for supplemental oxygen (OR 3.06, 95 % CI: 1.45-6.44) or mechanical ventilation (OR: 2.5, 95 % CI: 1.03-6.05) were independently associated with minor ECG abnormalities. Secondary analyses further demonstrated an independent association between level of respiratory support and ECG abnormalities only in the epilepsy group.
Significance:
Independent association of increased respiratory support with minor ECG abnormalities suggests a potential respiratory influence on the hearts of children with epilepsy.
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