Simultaneous electrocardiogram during routine electroencephalogram: arrhythmia rates through the eyes of the cardiologist

Abstract

Background: The importance of simultaneous 2-lead electrocardiogram (ECG) recording during routine electroencephalogram (EEG) has been reported several times on clinical grounds. Objective: To investigate arrhythmia rates detected by simultaneous 2-lead ECG in our patient sample undergoing routine EEG. Remarkably, we sought to assess the possible expansion of results with a more experienced interpretation of simultaneous ECG. Methods: Simultaneous 2-lead ECG recordings during routine EEG, performed between January and March, 2016, have been retrospectively analyzed by a cardiology specialist. In addition, EEG reports were screened with the keywords ‘arrhythmia, tachycardia, bradycardia, atrial fibrillation, extrasystole’ to evaluate the neurologist interpretation. Results: Overall, 478 routine EEG recordings were scanned. The mean age of the patients was 42.8±19.8 (16–95), with a sex ratio of 264/214 (F/M). In 80 (17%) patients, findings compatible with arrhythmia were identified on simultaneous ECG after a cardiologist's evaluation. The detected arrhythmia subtypes were: ventricular extrasystole (n=27; 5.6%), supraventricular extrasystole (n=23; 4.8%), tachycardia (n=9; 1.8%), prolonged QRS duration (n=7; 8.7%), atrial fibrillation (n=6; 1.2%), and block (n=6; 1.2%). On the other hand, keywords related to arrhythmia were present in 45 (9.4%) of EEG reports. The reported statements were tachycardia (3.3%), arrhythmia (2.5%), bradycardia (2.1%), and extrasystole (1.5%). Conclusions: A considerably high rate of arrhythmia cases was determined on simultaneous ECG during routine EEG after being interpreted by a cardiologist. However, the screening results of EEG reports revealed relatively low arrhythmia rates. These results suggest that the detection rates of ECG abnormalities during routine EEG may be potentially improved.

Diagnostic value of electrocardiogram during routine electroencephalogram

“…Our findings indicated that arrhythmias in total were more common in older patients, similar to Onder et al [20] but contrary to Kendirlie et al [3]. The differences are likely due to the different studied populations and different subtypes of reported arrhythmias.…”

“…Kendirli et al retrospectively detected EKG abnormalities in 18% of 376 patients who had a minimum of 20 min artifact-free EEG, the most common of which was supraventricular tachycardia [3]. Another study conducted by Onder et al in which simultaneous EKGs during 478 routine EEGs performed over three months were retrospectively scanned by a cardiologist and found that 80 (17%) patients had arrhythmias with ventricular extrasystole being the most frequent one [20]. The higher frequency of EKG abnormalities in our study could be attributed to the difference in patients' demographic characteristics.…”

“…Although some studies investigated EKG monitoring's value during prolonged EEG [16][17][18][19], the literature on utilizing EKG during routine/short EEG in diagnosing arrhythmia is scarce [3,20]. This study investigates the frequency and types of EKG abnormalities during routine EEG recording and its diagnostic value.…”

Routine Interictal EEG Recording Should be Performed Together with Simultaneous Two-Lead ECG Recording

“…Kendirli et al 8 detected ECG abnormalities in 68 (18%) of 376 patients (16–83 years of age) who underwent EEG testing due to prediagnosis of epilepsy or convulsive syncope. Onder et al 10 reported that the rate of arrhythmia was 17% on simultaneous ECG-EEG recordings by a cardiologist's evaluation in 478 adult patients who underwent routine testing. Yassin et al 11 evaluated 433 recordings of 365 adult patients (mean age: 46.8 years) and found ECG abnormalities in 28.5% of the patients.…”

The Value of Concurrent Electrocardiography When Performing an Electroencephalograph

“…6 The extended ECG trace which accompanies the EEG can also provide more insights into potential cardiac causes of presentations. 4,[7][8][9] The diagnostic utility of a concurrent ECG is relatively unknown. Previous studies have commented on its particular usefulness in syncope and the detection of newly identified cardiac dysrhythmias.…”