Epilepsy Is a Risk Factor for Sudden Cardiac Arrest in the General Population

Abstract

BackgroundPeople with epilepsy are at increased risk for sudden death. The most prevalent cause of sudden death in the general population is sudden cardiac arrest (SCA) due to ventricular fibrillation (VF). SCA may contribute to the increased incidence of sudden death in people with epilepsy. We assessed whether the risk for SCA is increased in epilepsy by determining the risk for SCA among people with active epilepsy in a community-based study.Methods and ResultsThis investigation was part of the Amsterdam Resuscitation Studies (ARREST) in the Netherlands. It was designed to assess SCA risk in the general population. All SCA cases in the study area were identified and matched to controls (by age, sex, and SCA date). A diagnosis of active epilepsy was ascertained in all cases and controls. Relative risk for SCA was estimated by calculating the adjusted odds ratios using conditional logistic regression (adjustment was made for known risk factors for SCA). We identified 1019 cases of SCA with ECG-documented VF, and matched them to 2834 controls. There were 12 people with active epilepsy among cases and 12 among controls. Epilepsy was associated with a three-fold increased risk for SCA (adjusted OR 2.9 [95%CI 1.1–8.0.], p = 0.034). The risk for SCA in epilepsy was particularly increased in young and females.ConclusionEpilepsy in the general population seems to be associated with an increased risk for SCA.

Leaky RyR2 channels unleash a brainstem spreading depolarization mechanism of sudden cardiac death

“…Over 150 RyR2 mutations have been identified in human CPVT1 cases, one of several calcium channelopathies underlying cardiac arrhythmias (34). We evaluated the RQ model for the presence of an epileptic phenotype, as epilepsy is an independent risk factor for sudden cardiac death (35,36). We found that mice bearing this mutation had strong evidence of cortical hyperexcitability in the form of frequent interictal cortical EEG spike discharges, a neurophysiological biomarker of epilepsy.…”

Cardiac arrhythmias during or after epileptic seizures

“…32 People with epilepsy were found to have a threefold increased risk of VT/VF compared with the general population. 33 Most cases of VT/VF in epilepsy were, however, not seizure-related and were probably related to cardiovascular comorbidities. Nevertheless, in a subset of cases, seizure-induced VF may have played a role.…”

Atrial Fibrillation Is an Independent Risk Factor for Ventricular Fibrillation

“…ARREST and HAG-net-AMC are ongoing, prospective, community-based studies. [13][14][15] ARREST is designed to study the clinical, pharmacological, and genetic determinants and outcome of OHCA in the community. 13 The ARREST research group prospectively collects data of all cardiopulmonary resuscitation efforts for OHCA from cardiac causes in a contiguous region of the Netherlands (population >2.4 million) in collaboration with all Emergency Medical Services in this study region, using a mandatory multiple-source notification system (consisting of dispatch centers, ambulance services, and all 14 area hospitals).…”

“…14,15 Data in HAG-net-AMC are representative for the community because, in the Netherlands, every citizen has a GP, and GPs have a complete overview of all diagnoses made by medical specialists.…”