Abstract
Background and Objectives: People with epilepsy (PWE) have a 2–3 times higher mortality rate than the general population. Sudden unexpected death in epilepsy (SUDEP) comprises a significant proportion of premature deaths, whereas sudden cardiac death (SCD) is among the leading causes of sudden death in the general population. Cardiac pathologies are significantly more prevalent in PWE. Whether electrocardiographic (ECG) parameters are associated with remote death in PWE has yet to be elucidated. The study objective was to assess whether interictal ECG parameters are associated with mortality in the long-term. Materials and Methods: The study involved 471 epilepsy patients who were hospitalized after a bilateral tonic-clonic seizure(s). ECG parameters were obtained on the day of hospitalization (heart rate, PQ interval, QRS complex, QT interval, heart rate corrected QT interval (QTc), ST segment and T wave changes), as well as reported ECG abnormalities. Mortality data were obtained from the Latvian National Cause-of-Death database 3–11, mean 7.0 years after hospitalization. The association between the ECG parameters and the long-term clinical outcome were examined. Results: At the time of assessment, 75.4% of patients were alive and 24.6% were deceased. Short QTc interval (odds ratio (OR) 4.780; 95% confidence interval (CI) 1.668–13.698; p = 0.004) was associated with a remote death. After the exclusion of known comorbidities with high mortality rates, short QTc (OR 4.631) and ECG signs of left ventricular hypertrophy (OR 5.009) were associated with a remote death. Conclusions: The association between routine 12-lead rest ECG parameters—short QTc interval and a pattern of left ventricular hypertrophy—and remote death in epilepsy patients was found. To the best of our knowledge, this is the first study to associate rest ECG parameters with remote death in an epileptic population.
Highlights
Causes of death in people with epilepsy can be classified into three groups: deaths that are unrelated to epilepsy, those that occur as a result of the underlying cause of epilepsy, and those in which the epilepsy itself is the cause of death [2,3]
Deaths occurring in status epilepticus and in accidents caused by seizures, such as drowning and burns, as well as those caused by aspiration, asphyxiation, and Sudden unexpected death in epilepsy (SUDEP), are recognized as epilepsy-related deaths [3,4]
Mediated hypoventilation has the predominant role in most recorded cases, whereas seizure-induced ventricular arrhythmia is a rare cause of SUDEP [14]
Summary
People with epilepsy have a mortality rate 2–3 times higher than that of the general population [1,2]. Deaths occurring in status epilepticus and in accidents caused by seizures, such as drowning and burns, as well as those caused by aspiration, asphyxiation, and SUDEP (sudden unexpected death in epilepsy), are recognized as epilepsy-related deaths [3,4]. SUDEP is defined as a sudden, unexpected, witnessed or unwitnessed, non-traumatic, and non-drowning death in patients with epilepsy, with or without evidence of seizure, excluding documented SE, in which post-mortem examination does not reveal a toxicological or anatomical cause of death [5]. The standardized mortality ratio for SUDEP is nearly 24 times higher compared with sudden death in the general population [6]. Cardiorespiratory findings are consistent with the mechanisms that were suspected to result in SUDEP more than two decades ago [15]
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