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Las arritmias cardíacas en la epilepsia focal: un estudio prospectivo a largo plazo
Fergus J Rugg-Gunn1, Robert J Simister, Mark Squirrell
1National Society for Epilepsy and Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK.
Lancet (London, England)
|December 22, 2004
Resumen
La muerte súbita inesperada en la epilepsia puede ser causada por arritmias cardíacas como la asistolia. El monitoreo continuo del electrocardiograma (ECG) reveló eventos cardíacos significativos durante las convulsiones en pacientes con epilepsia de alto riesgo.
Área de la Ciencia:
- Neurología Neurología.
- Cardiología Cardiología.
- Investigación de la epilepsia en la investigación de la epilepsia.
Sus antecedentes:
- Los pacientes con epilepsia se enfrentan a un riesgo de muerte súbita e inesperada, potencialmente debido a arritmias cardíacas neurogénicas.
- Los electrocardiogramas (ECG) ofrecen un método para monitorear la función cardíaca, con grabadores de bucle implantables que proporcionan una vigilancia extendida de hasta 18 meses.
Objetivo del estudio:
- Para determinar la frecuencia de las arritmias cardíacas en pacientes que experimentan convulsiones focales refractarias durante un período de seguimiento prolongado.
Principales métodos:
- Se utilizó un grabador de bucle implantable para monitorear a 20 pacientes con convulsiones focales refractarias en el Reino Unido.
- Los dispositivos fueron programados para detectar bradicardia (<40 bpm) o taquicardia (>140 bpm) y permitieron el inicio manual de la grabación de ECG durante las convulsiones.
- Se analizaron los datos del ECG y se correlacionaron con los diarios de convulsiones de los pacientes durante 24 meses.
Principales resultados:
- Se monitorearon más de 220.000 horas-paciente, capturando ECGs durante 377 convulsiones.
- La frecuencia cardíaca promedio excedió los 100 latidos por minuto durante las convulsiones habituales en 16 pacientes.
- La bradicardia ictal ocurrió en el 2,1% de los eventos (7 pacientes), y el 21% de los pacientes experimentaron bradicardia o asistolia, lo que requirió la inserción de marcapasos en cuatro pacientes, incluidos tres con asistolia potencialmente fatal.
Conclusiones:
- Las anomalías cardíacas periictales en pacientes con epilepsia comparten características con las personas con mayor riesgo de muerte súbita e inesperada.
- La asistolia puede ser un factor significativo en muchas muertes relacionadas con la epilepsia, lo que afecta a la investigación del paciente y las estrategias de ritmo cardíaco.
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