Risk of ECG abnormalities and arrhythmias in people with post-traumatic epilepsy

People with traumatic brain injury (TBI), particularly those who develop post-traumatic epilepsy (PTE, unprovoked seizure >1-week post-TBI), are at a high risk of mortality. Lethal arrhythmias represent one potential cause of mortality.

The goal of this study is to investigate the risk of electrocardiographic (ECG) abnormalities and arrhythmias in people with TBI that develop PTE vs. those that do not.

Analysis was performed using the TriNetX platform. Selection criteria included one lifetime TBI, 18-55 years old at the time of TBI, and survived > 1-week post-TBI. People with pre-TBI history of seizures, epilepsy, arrhythmias, or heart disease were excluded. We compared the time-dependent risk of arrhythmias and ECG abnormalities > 1-week post-TBI in PTE (seizure or epilepsy diagnosis >1-week post-TBI) versus propensity-score-matched non-PTE cohorts (N = 11,092/group). Follow-up was 1-week to 10-years post-TBI.

PTE is associated with a 3-fold increased prevalence of the composite outcome (all ECG abnormalities and arrhythmias) and 5-fold increased prevalence of ventricular arrhythmias. There is decreased freedom from (log-rank p < 0.001), and increased time-dependent risk of the composite outcome (hazard-ratio: 2.26 [2.11-2.42]), and each type of ECG abnormality and arrhythmia. Sub-analysis stratifying for type of TBI, presence/absence of anti-seizure medications, post-traumatic (≤48-hours post-TBI) seizures, and post-traumatic arrhythmias, each demonstrate that people with PTE are at an increased risk of ECG abnormalities and arrhythmias.

Results indicate the high risk of ECG abnormalities and arrhythmias in PTE. While PTE is principally a neurological disorder, it is important to take a multi-system approach that includes cardiac monitoring.