The yield of long-term electrocardiographic recordings in refractory focal epilepsy.

Autor: van der Lende M; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands.; Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands., Arends JB; Academic Center for Epileptology Kempenhaeghe, Heeze, the Netherlands.; Signal Processing Group, Electronic Engineering Faculty, Technological University Eindhoven, Eindhoven, the Netherlands., Lamberts RJ; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands., Tan HL; Heart Center, Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands., de Lange FJ; Heart Center, Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands., Sander JW; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands.; National Institute for Health Research University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UK.; Chalfont Centre for Epilepsy, Chalfont St Peter, UK., Aerts AJ; Department of Cardiology, Zuyderland Medical Center, Heerlen, the Netherlands., Swart HP; Department of Cardiology, Antonius Hospital Sneek, Sneek, the Netherlands., Thijs RD; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands.; Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.; National Institute for Health Research University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UK.; Chalfont Centre for Epilepsy, Chalfont St Peter, UK.
Jazyk: angličtina
Zdroj: Epilepsia [Epilepsia] 2019 Nov; Vol. 60 (11), pp. 2215-2223. Date of Electronic Publication: 2019 Oct 21.
DOI: 10.1111/epi.16373
Abstrakt: Objective: To determine the incidence of clinically relevant arrhythmias in refractory focal epilepsy and to assess the potential of postictal arrhythmias as risk markers for sudden unexpected death in epilepsy (SUDEP).
Methods: We recruited people with refractory focal epilepsy without signs of ictal asystole and who had at least one focal seizure per month and implanted a loop recorder with 2-year follow-up. The devices automatically record arrhythmias. Subjects and caregivers were instructed to make additional peri-ictal recordings. Clinically relevant arrhythmias were defined as asystole ≥ 6 seconds; atrial fibrillation < 55 beats per minute (bpm), or > 200 bpm and duration > 30 seconds; persistent sinus bradycardia < 40 bpm while awake; and second- or third-degree atrioventricular block and ventricular tachycardia/fibrillation. We performed 12-lead electrocardiography (ECG) and tilt table testing to identify non-seizure-related causes of asystole.
Results: We included 49 people and accumulated 1060 months of monitoring. A total of 16 474 seizures were reported, of which 4679 were captured on ECG. No clinically relevant arrhythmias were identified. Three people had a total of 18 short-lasting (<6 seconds) periods of asystole, resulting in an incidence of 2.91 events per 1000 patient-months. None of these coincided with a reported seizure; one was explained by micturition syncope. Other non-clinically relevant arrhythmias included paroxysmal atrial fibrillation (n = 2), supraventricular tachycardia (n = 1), and sinus tachycardia with a right bundle branch block configuration (n = 1).
Significance: We found no clinically relevant arrhythmias in people with refractory focal epilepsy during long-term follow-up. The absence of postictal arrhythmias does not support the use of loop recorders in people at high SUDEP risk.
(© 2019 Universiteit Leiden. Epilepsia published by Wiley Periodicals, Inc. on behalf of International League Against Epilepsy.)
Databáze: MEDLINE
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