Electrocardiography characteristics and long-term mortality in people with epilepsy from a resource-poor community

Data on electrocardiography (ECG) characteristics and their associations with mortality in people with epilepsy from resource-poor communities remain limited. This study aimed to investigate these associations within a prospective cohort in rural China.

We conducted an exploratory analysis within a prospective epilepsy cohort in rural China. Baseline 12-lead ECG recordings were evaluated using the Minnesota Code and continuous interval measurements. Associations with long-term mortality, including sudden unexpected death in epilepsy (SUDEP), were assessed using Cox regression models.

Among 442 participants included in the analysis, 30 deaths occurred during a mean follow-up of 5.9 years, including 12 SUDEP cases. Half of the participants exhibited at least one baseline ECG abnormality. The most prevalent morphological abnormalities were T-wave abnormalities (27.3%), arrhythmias (17.5%), and ST-segment depression (8.2%), with T-wave abnormalities showing a higher prevalence in older participants. Minnesota Code-defined ventricular conduction defects were associated with an increased risk of SUDEP (adjusted hazard ratio [HR] 6.53, 95% confidence interval [CI] 1.42-30.10). High-amplitude R waves were associated with non-epilepsy-related mortality (adjusted HR 15.68, 95% CI 3.37-72.92).

ECG abnormalities were common in people with epilepsy. Ventricular conduction defects or high-amplitude R waves were associated with SUDEP or non-epilepsy-related mortality. ECG could be helpful in recognizing people with epilepsy with high risk of premature death, particularly in resource-poor settings.