Cardiology perspective on seizure-related bradyarrhythmias and SUDEP: A survey study

Abstract

ObjectiveTo determine cardiologist knowledge of and experience with seizure-related bradyarrhythmias and sudden unexpected death in epilepsy (SUDEP). BackgroundAutonomic changes related to acute seizures are common and can occur during the ictal or postictal period. Two concerning changes in these periods are significant bradycardia and asystole. Postictal asystole has been investigated as a potential mechanism for SUDEP. MethodsA 27-question survey delivered to cardiologists and cardiology fellows assessed demographics, personal experience, and training involving SUDEP and seizure-related bradycardia and asystole. Following IRB approval, a list of US cardiology fellowships was constructed using the AAMC public website. Surveys were distributed by email to all programs whose program director or coordinator’s email was readily available on their website. They were asked to forward the survey to both cardiology fellows and practicing cardiologists. ResultsFifty one surveys were completed: 23 from fellows and 28 from practicing cardiologists. Forty nine were from academic centers. Twenty four respondents (47%) reported being consulted for ictal bradycardia or asystole. Nine and 13 recommended treatment for ictal bradycardia or ictal asystole, respectively. Nineteen respondents (37%) reported being consulted for postictal bradycardia or asystole. Eight recommended treatment for postictal bradycardia or asystole, respectively. Treatment recommendations included medical management and/or pacemaker. None reported a substantial knowledge of SUDEP. The most common response interrogating SUDEP awareness (63%) was “no knowledge of SUDEP”. Formal SUDEP education was not reported by any participant with only one reporting formal didactics regarding seizure-related arrhythmias. DiscussionOur results suggest ictal bradyarrhythmias are less commonly known to cardiologists, with SUDEP awareness being far less. Formal education to cardiologists on these two topics could prove beneficial at the intersection of cardiology and care for patients with epilepsy.