Abstract 16882: Electrocardiographic Characteristics of Patients With Sudden Unexplained Death in Epilepsy
Introduction: Sudden unexplained death in epilepsy (SUDEP) can occur in a subset of patients with epilepsy. Animal studies and sporadic cases suggest a link between SUDEP and cardiac channelopathy. Here, we tested the hypothesis that ECG features may distinguish SUDEP cases from living subjects with epilepsy.
Methods: Using a matched case-control design, we compared ECGs of 12 consecutive cases of SUDEP over 10 years and 22 epilepsy controls matched for age, gender, ICD 9 code, antiepileptic and antipsychotic drug classes. A single ECG with available concurrent medication list was used for each subject. Blinded ECG interpretation was performed by two experienced readers and adjudicated by a third reader. QT interval was measured manually from lead V2 and corrected via Bazett’s formula. Each ECG was assessed for presence of (a) abnormal ventricular conduction diagnosis (defined by QRS ≥110 ms); (b) abnormal ventricular conduction pattern (defined by morphology of incomplete right or left bundle branch block or intraventricular conduction delay with QRS <110 ms); (c) early repolarization (ER); or (d) diagnostic features of inherited cardiac channelopathies.
Results: Cases (age 43±16years; 58% male; 75% Caucasian) and controls (age 41±15years; 59% male; 64% Caucasian) were well-matched. Heart rate, PR, QRS, and QTc intervals were similar and within normal limits. Abnormal ventricular conduction diagnosis was present in 2 cases and no controls. Abnormal ventricular conduction pattern was more common in cases than controls (58% vs. 18%, p=0.04), independent of age, gender, race, and drug regimen. ER was present in similar proportions of cases and controls. Overall prevalence of ER (21%) exceeded that of community-based cohorts (6.1%, p<0.01) with similar demographics.
Conclusions: Abnormal ventricular conduction pattern was more common in SUDEP compared to controls. No ECG evidence of inherited cardiac channelopathies was detected in SUDEP group. ER may be more prevalent in epilepsy subjects, a finding that may reflect medication effects or underlying disease process, meriting further research. Strengths of this study included medication matching, detailed interpretation of ventricular conduction morphology, and large adjudicated SUDEP cohort.
- © 2013 by American Heart Association, Inc.