Abnormal ECG Findings in Children Undergoing Seizure Evaluation

Purpose: The objective of this study was to describe electrocardiogram (ECG) abnormalities captured during video electroencephalogram monitoring in a series of children and adolescents. Methods: This is a multicenter case series from four pediatric comprehensive epilepsy centers. There was no systematic review of a database; this was a case series with variable methods of patient recall/identification. Patients were divided into three groups according to ECG findings: (1) ictal ECG abnormalities (excluding sinus tachycardia), (2) cardiac disease mimicking seizures, and (3) incidental ECG abnormalities found during electroencephalogram/video-electroencephalogram monitoring. Ictal asystole was defined as an RR interval longer than 3 seconds and at least twice as long as the previous RR interval. Results: There were 22 patients identified with pathologic ECG findings (7 females, 15 males), ranging from 5 months old to 17 years old (mean = 9.3 years). Ictal ECG abnormalities were seen in five patients: asystole in three, and bradycardia and second-degree heart block in one each. Cardiac arrhythmia triggering syncope/altered mental status was seen in 11 patients: asystole in three; Wolff–Parkinson–White syndrome in three; premature ventricular contraction in two; and ventricular tachycardia, second-degree heart block, and Brugada syndrome in one each. Incidental ECG abnormalities were found in six patients (premature ventricular contraction in four, second-degree heart block and bradycardia in one each). Conclusions: The identification of cardiac abnormalities in children undergoing evaluation for a possible seizure disorder allows not only optimization of seizure management but also guides differential diagnosis, specific cardiological interventions, and avoidance of antiseizure medication that might exacerbate cardiac arrhythmias. It is crucial to pay attention to the ECG channel of the electroencephalogram recordings, especially in the peri-ictal period.