June 2, 2015Journal of Neurology Neurosurgery & Psychiatry304 citationsOpen Access
Cardiac arrhythmias during or after epileptic seizures
Structured PICO
What are the clinical profiles and patterns of cardiac arrhythmias occurring during or after epileptic seizures?
P
Population
Patients with epilepsy experiencing cardiac arrhythmias during or after epileptic seizures (171 cases identified from case reports and case series).
O
Outcome
Clinical profiles and patterns associated with various (post)ictal cardiac arrhythmias.
Postictal arrhythmias are mostly found following convulsive seizures and are often associated with SUDEP, whereas ictal arrhythmias are typically self-limiting and seen during focal dyscognitive seizures.
Abstract
Seizure-related cardiac arrhythmias are frequently reported and have been implicated as potential pathomechanisms of Sudden Unexpected Death in Epilepsy (SUDEP). We attempted to identify clinical profiles associated with various (post)ictal cardiac arrhythmias. We conducted a systematic search from the first date available to July 2013 on the combination of two terms: 'cardiac arrhythmias' and 'epilepsy'. The databases searched were PubMed, Embase (OVID version), Web of Science and COCHRANE Library. We attempted to identify all case reports and case series. We identified seven distinct patterns of (post)ictal cardiac arrhythmias: ictal asystole (103 cases), postictal asystole (13 cases), ictal bradycardia (25 cases), ictal atrioventricular (AV)-conduction block (11 cases), postictal AV-conduction block (2 cases), (post)ictal atrial flutter/atrial fibrillation (14 cases) and postictal ventricular fibrillation (3 cases). Ictal asystole had a mean prevalence of 0.318% (95% CI 0.316% to 0.320%) in people with refractory epilepsy who underwent video-EEG monitoring. Ictal asystole, bradycardia and AV-conduction block were self-limiting in all but one of the cases and seen during focal dyscognitive seizures. Seizure onset was mostly temporal (91%) without consistent lateralisation. Postictal arrhythmias were mostly found following convulsive seizures and often associated with (near) SUDEP. The contrasting clinical profiles of ictal and postictal arrhythmias suggest different pathomechanisms. Postictal rather than ictal arrhythmias seem of greater importance to the pathophysiology of SUDEP.