Electrocardiography in epilepsy patients without cardiac symptoms

Sudden unexpected death in epilepsy (SUDEP) has been ascribed to cardiac arrhythmia, possibly triggered by cerebral events. Young, noncompliant, substance-abusing males with convulsions may be at risk. EEG/ECG studies have not shown significant cardiac arrhythmias in these and other seizure patients. We reviewed resting ECGs in 75 epilepsy patients and compared ventricular rate, PR interval, QRS duration, and QT interval corrected for heart rate (QTC) with normal ECGs recorded in age-matched patients without cardiac or neurologic disorders. No potentially lethal arrhythmias were noted in the seizure patients. Patients who fit the previously-described profile of high risk of SUDEP had more abnormal ECGs and ventricular rate was faster in these patients than in other epileptics. Patients with complex partial and secondarily generalized seizures had faster ventricular rates than other epileptics. No differences were noted in QRS duration or PR interval. QT was longer in patients with complex partial seizures than in control ECGs or other epileptic patients. These findings suggest that resting ECG has low diagnostic yield in epilepsy patients without cardiac symptoms. The factors possibly predisposing to SUDEP may relatively increase resting heart rate, however, and relatively increased QT interval with complex partial seizures may indicate some differences, possibly neurally-mediated, in cardiac excitability which could contribute to SUDEP.