- Email: [email protected]
Cardiac arrhythmias in focal epilepsy: A prospective long-term study
Cardiac Arrhythmias in Focal Epilepsy: A Prospective Long-Term Study
end of 8 seizures in 7 patients: asystole lasting 5–18 s in 3 patients, and bradycardia with a rate of 25– 40 beats/min for 10 –30 s in 4 patients. A pacemaker was implanted in the 3 patients with asystole and in 1 of the patients with severe bradycardia. Conclusions: Asystole may account for sudden death that occurs during epileptic seizures. Perspective: It seems very plausible that stimulation of central parasympathetic centers during a seizure could cause asystole. This could be thought of as a variant of neurocardiogenic syncope. Less plausible is that asystole caused by vagal discharge during a seizure is responsible for sudden death. Long episodes of asystole are commonly observed during typical episodes of neurocardiogenic syncope, yet cardiac arrest or death in this setting is extremely rare. Therefore, the clinical significance of ictal asystole and whether it should be treated with a pacemaker remain unclear. FM
Rugg-Gunn FJ, Simister RJ, Squirrell M, Holdright DR, Duncan JS. Lancet 2004;364:2212–9. Study Question: Seizure-related deaths often are sudden and unexpected. To investigate the possible cause of these sudden deaths, this study determined how often serious arrhythmias are precipitated by seizures in patients with epilepsy. Methods: An implantable loop recorder (ILR) was placed in 19 patients (mean age 40 years) with refractory seizures and no cardiac disease. Events were recorded either by patient activation or automatically when the rate was ⬍40 or ⬎140 beats/ min. The median duration of follow-up was 18 months. Results: An ILR recording was obtained during 377 seizures. Sinus tachycardia was observed in all patients during at least some seizures. No ventricular arrhythmias were observed. Marked bradycardia was observed near the
ACC CURRENT JOURNAL REVIEW April 2005
48
end of 8 seizures in 7 patients: asystole lasting 5–18 s in 3 patients, and bradycardia with a rate of 25– 40 beats/min for 10 –30 s in 4 patients. A pacemaker was implanted in the 3 patients with asystole and in 1 of the patients with severe bradycardia. Conclusions: Asystole may account for sudden death that occurs during epileptic seizures. Perspective: It seems very plausible that stimulation of central parasympathetic centers during a seizure could cause asystole. This could be thought of as a variant of neurocardiogenic syncope. Less plausible is that asystole caused by vagal discharge during a seizure is responsible for sudden death. Long episodes of asystole are commonly observed during typical episodes of neurocardiogenic syncope, yet cardiac arrest or death in this setting is extremely rare. Therefore, the clinical significance of ictal asystole and whether it should be treated with a pacemaker remain unclear. FM
Rugg-Gunn FJ, Simister RJ, Squirrell M, Holdright DR, Duncan JS. Lancet 2004;364:2212–9. Study Question: Seizure-related deaths often are sudden and unexpected. To investigate the possible cause of these sudden deaths, this study determined how often serious arrhythmias are precipitated by seizures in patients with epilepsy. Methods: An implantable loop recorder (ILR) was placed in 19 patients (mean age 40 years) with refractory seizures and no cardiac disease. Events were recorded either by patient activation or automatically when the rate was ⬍40 or ⬎140 beats/ min. The median duration of follow-up was 18 months. Results: An ILR recording was obtained during 377 seizures. Sinus tachycardia was observed in all patients during at least some seizures. No ventricular arrhythmias were observed. Marked bradycardia was observed near the
ACC CURRENT JOURNAL REVIEW April 2005
48