Electrocardiographic repolarization and conduction abnormalities in pediatric epilepsy

To evaluate subclinical alterations in cardiac conduction and ventricular repolarization in children with epilepsy by comparing corrected QT dispersion (QTcd), Tpeak-Tend (Tp-e) interval, Tp-e-based ratios, and P-wave dispersion (PWD) between pediatric epilepsy patients and healthy controls. A secondary aim was to explore electrophysiological differences between electrocardiographic recordings obtained during emergency department (ED) presentations and interictal outpatient evaluations.

In this prospective case-control study, 149 children with epilepsy and 75 age- and sex-matched healthy controls underwent standardized 12-lead electrocardiography using a Nihon Kohden Cardiofax GEN system. ECG parameters included heart rate, PR interval, QT and QTc intervals, QTcd, Tp-e interval, Tp-e/QTc ratio, Tp-e/QTmax interval, QRS duration, and P-wave dispersion. Subgroup analyses were performed between ED and outpatient cohorts. Statistical significance was defined as p < 0.05.

Children with epilepsy demonstrated longer PR intervals, higher P-wave dispersion, and increased QTc, QTcd, Tp-e interval, Tp-e/QTc ratio, QRS duration, QTcde, and QTcdpre values compared with controls (all p < 0.05). P-wave duration was shorter in the epilepsy group (p = 0.008), while heart rate was modestly higher but did not reach statistical significance (p = 0.059). With the exception of the Tp-e/QTmax interval, most conduction and repolarization parameters differed between ED and outpatient subgroups. Outpatient recordings were associated with more pronounced ventricular repolarization changes, whereas ED recordings showed greater atrial conduction differences. Antiseizure medication therapy was not significantly associated with ECG parameters.

Children with epilepsy exhibit measurable but subclinical differences in selected atrial conduction and ventricular repolarization parameters compared with healthy controls. These findings do not indicate established cardiac pathology, but may reflect autonomic or cardiac electrical modulation related to epilepsy or seizure-associated factors. The results should be interpreted as hypothesis-generating and underscore the need for prospective longitudinal studies incorporating clinical cardiac outcomes.