Abstract 12769: Antiepileptic Medication and the Risk for Sudden Cardiac Death Caused by an Acute Coronary Event
Introduction: Epilepsy is associated with an increased prevalence of sudden cardiac death (SCD). It is not well known, if this association is caused by the disease itself or by the use of antiepileptic medication, many of which have influence on the cardiac ion channel functions. We studied the role of antiepileptic drugs as a triggering factor of SCD in a large case-control study.
Methods: The FinGesture study population was derived from autopsies of victims of SCD caused by an acute coronary event in Northern Finland during 1998-2007. The use of medication was compared between victims of SCD and survivors of an acute coronary event in a case-control study including a consecutive series of victims of SCD (n=2674, mean age 62.8±12.3y) verified at medico-legal autopsy and consecutive series of patients surviving an acute myocardial infarction (AMI; n=1120, mean age 65.5±12.0y). The medication history was obtained from autopsy/hospital records and interviews with relatives of SCD victims and AMI patients.
Results: The use of antiepileptic medication was more common in the SCD than AMI group (4.6% vs. 2.0%, odds ratio [OR] 2.4, 95% confidence interval [CI] 1.5-3.8; P≤0.001). In a survey of national drug reimbursement register, 0.7% of the general population in Finland had a continuous antiepileptic medication (p≤0.001 as compared to two other groups). The use of antiepileptic drugs remained as a significant risk factor for SCD after adjustment for confounding variables (OR 2.3, 95% CI 1.5-3.7; P≤0.001). Nearly half of the SCD victims used antiepileptic drugs for other indication than epilepsy, e.g. for trigeminal neuralgia or neuropathic pain syndromes. Antiepileptic drugs used for indications other than epilepsy was also more common in the SCD victims than AMI survivors (p≤0.001).
Conclusions: In conclusion, the use of antiepileptic drugs is associated with an increased risk of SCD during an acute ischemic event, even in subjects without epilepsy, suggesting that antiepileptic drugs have a substantial effect on the excess in the prevalence of SCD in epilepsy patients.
- © 2013 by American Heart Association, Inc.