Cardiac abnormalities and repolarization variability in epilepsy: influence of antiseizure medications and treatment
Cagdas Kaynak1, Ayfer Ertekin2, Mehmet Attila Erkuzu2
1Depatment of Cardiology, Siirt Education and Research Hospital, Siirt, Türkiye.
Objective:
This study aimed to investigate the effects of different antiseizure medications (ASMs) and clinical treatment response on interictal electrocardiographic (ECG) repolarization indices and echocardiographic structural and functional cardiac parameters in patients with epilepsy.
Methods:
This single-center, prospective, cross-sectional study was conducted between August 2024 and February 2025 at the Neurology and Cardiology Departments of Siirt Training and Research Hospital. The study included 97 patients with epilepsy and 57 age- and sex-matched healthy controls. Patients were classified as drug-sensitive or drug-resistant based on the International League Against Epilepsy (ILAE) criteria. While both monotherapy and polytherapy users were included in clinical comparisons, subgroup analyses by ASM type involved only monotherapy patients. ECG and echocardiographic parameters were assessed. Group comparisons and correlation analyses were performed using analysis of variance (ANOVA), chi-square test, and Pearson correlation.
Results:
No significant differences in demographic or interictal ECG repolarization indices were found between the drug-sensitive, drug-resistant, and control groups (P > 0.05). Both epilepsy groups had significantly higher left atrial volum index (LAVi) compared to controls (P < 0.001), while A velocity and lateral E' were significantly lower. Carbamazepine (CBZ) group showed the highest LAVi, though without correlation to treatment duration. In contrast, valproic acid (VPA) and levetiracetam (LEV) groups exhibited significant positive correlations between treatment duration and LAVi (r = 0.776, P = 0.002; r = 0.571, P = 0.002, respectively).
Conclusion:
Treatment with ASMs in epilepsy is associated with left atrial enlargement, particularly with CBZ. The absence of interictal ECG repolarization differences suggests that isolated assessments may be insufficient, supporting long-term cardiac monitoring in epilepsy management.
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