Epileptic Patients are at Risk of Cardiac Arrhythmias: A Novel Approach using QT-nomogram, Tachogram, and Cardiac Restitution Plots

Abstract

Background:Sudden death is reported in patients who had a history of epilepsy and some authors believed that is due to cardiac arrhythmias.Objectives:This study aimed to predict that the epileptic patients are at risk of serious cardiac arrhythmias by QT-nomogram, tachogram (Lorenz), and cardiac restitution plots.Methods:A total number of 71 healthy subjects (Group I) and 64 newly diagnosed epileptic patients (Group II) were recruited from Al-Yarmouk and Baghdad Teaching hospitals in Baghdad from March 2015 to July 2015 and included in this study. The diagnosis of epilepsy achieved clinically, electroencephalograph record and radio-images including computerized tomography and magnetic image resonance. At the time of entry into the study, an electrocardiography (ECG) was done, and the determinants of each ECG record were calculated. The QT-nomogram, tachogram, and cardiac restitution plots were used to identify the patients at risk of cardiac arrhythmias.Results:Significant prolonged corrected QT corrected (QTc) and JT corrected intervals were observed in female compared with male at age ≥50 years while the TQ interval was significantly prolonged in males of Group II. Eight patients of Group II had a significant pathological prolonged QTc interval compared with undetectable finding in Group I. QT nomogram did not disclose significant findings while the plots of Lorenz and restitution steepness disclose that the patients of Group II were vulnerable to cardiac arrhythmias. Abnormal ECG findings were observed in the age extremities (≤18 years and ≥50 years) in Group II compared with Group I.Conclusion:Utilization of QT-nomogram, restitution steepness, and tachogram plots is useful tools for detection subclinical vulnerable epileptic patient with cardiac arrhythmias.

Burden of Arrhythmias in Epilepsy Patients: A Nationwide Inpatient Analysis of 1.4 Million Hospitalizations in the United States

“…The burden of other subtypes of arrhythmia in epilepsy patients is shown in detail in Figure 1 . Many arrhythmia subtypes have been associated with epilepsy patients [ 3 , 8 - 9 ].…”

“…Therefore, heart rate is also an important marker to prevent serious cardiac morbidity in epilepsy. Such variations should not be neglected as it can have hazardous consequences [ 3 - 4 ].…”

Effect of Intractable Epilepsy on the Physiological Cardiac Performance Parameters and the Serum Levels of Cardiac Fatty Acid Binding Protein in Pediatrics

“…Similar findings were reported by other authors [5,13] while other authors reported similar QTc interval durations in both groups [28,29] . However, a significant increase in QTc values were reported in other studies among epileptic patients compared to the control group [30,31] .…”

Beat‐to‐beat ECG restitution: A review and proposal for a new biomarker to assess cardiac stress and ventricular tachyarrhythmia vulnerability

“…Both measures performed better than time-domain heart rate variability analysis. Most recently, restitution has been used in a rural setting as a readily available way of assessing arrhythmia liability in epileptic patients (Al-Nimer, Al-Mahdawi, & Abdullah, 2017). In a study comparing 71 healthy subjects versus 64 newly diagnosed epileptic patients, QT nomograms did not disclose significant findings while restitution steepness showed that epileptic patients were vulnerable.…”