Serious Cardiac Arrhythmias Detected by Subcutaneous Long-term Cardiac Monitors in Patients With Drug-Resistant Epilepsy.

Abstract

Epilepsy is associated with an increased risk of cardiovascular disease and premature mortality, including sudden unexpected death in epilepsy (SUDEP). Of concern, serious cardiac arrythmias might go undetected from routine epilepsy and cardiac investigations. This prospective cohort study aimed to detect cardiac arrhythmias in patients with chronic drug-resistant epilepsy (≥5 years duration) using subcutaneous cardiac monitors for a minimum follow-up duration of 12 months. Participants with known cardiovascular disease or those with abnormal 12-lead electrocardiograms were excluded. The device was programmed to automatically record episodes of tachycardia ≥140 beats per minute (bpm), bradycardia ≤40 bpm for ≥3 seconds, or asystole ≥3 seconds. Thirty-one patients underwent subcutaneous cardiac monitoring for a median recording duration of 2.2 years (range 0.5 to 4.2). During this time, 28 (90.3%) patients had episodes of sustained (≥30s) sinus tachycardia, 8/31 (25.8%) had sinus bradycardia, and 3 (9.7%) had asystole. Three (9.7%) patients had serious cardiac arrhythmias requiring additional cardiac interventions. Among them, two patients had prolonged sinus arrest and ventricular asystole (>6 seconds), leading to pacemaker insertion in one; and another patient with an epileptic encephalopathy had multiple episodes of recurrent non-sustained polymorphic ventricular tachycardia and bundle branch conduction abnormalities. The time to first detection of a clinically significant cardiac arrhythmia ranged between 1.2 to 26.9 months following cardiac monitor insertion. Implantable cardiac monitors detected a high incidence of clinically significant cardiac arrhythmias in patients with chronic drug resistant epilepsy, which may contribute to the incidence of premature mortality including SUDEP.