Cardiac Arrhythmias in Epilepsy: Troublemaker, Accomplice, or Innocent Bystander?

Patients with epilepsy experience an excess burden of morbidity and mortality. Premature death occurs at twice the rate expected for age, and sudden unexplained death in epilepsy (SUDEP) is the leading epilepsy-related cause of death. 1 Sillanpää M. Shinnar S. Long-term mortality in childhood-onset epilepsy. N Engl J Med. 2010; 363: 2522-2529 Crossref PubMed Scopus (263) Google Scholar Peri-ictal arrhythmias were first described in the late 19th and 20th centuries. 2 Russell A. Cessation of the pulse during the onset of epileptic fits: with remarks on the mechanism of fits. Lancet. 1906; 168: 152-154 Abstract Scopus (23) Google Scholar However, the clinical significance of heart rhythm disturbance in epilepsy and, in particular, their potential role in SUDEP remains unclear. Case reports and case series dominate the available literature, most commonly in the setting of inpatient video electroencephalography with the limitations of short-term monitoring as well as confounding factors such as antiarrhythmic drug withdrawal. 3 van der Lende M. Surges R. Sander J.W. Thijs R.D. Cardiac arrhythmias during or after epileptic seizures. J Neurol Neurosurg Psychiatry. 2016; 87: 69-74 PubMed Google Scholar Long-term monitoring is needed to understand the clinical implications of rhythm disturbance in epilepsy. Cardiac arrhythmias and sudden unexpected death in epilepsy: Results of long-term monitoringHeart RhythmVol. 18Issue 2PreviewCardiac rhythm and conduction disorders are common in patients with epilepsy and are presumably one of the leading causes of sudden unexpected death. There are only a few published reports on ictal cardiac arrhythmias detected by continuous monitoring, and the majority had a small sample size. Full-Text PDF