Key result
Epilepsy is linked to ~76% higher risk of out-of-hospital cardiac arrest vs the general population.
Why the study?
Previous studies suggested epilepsy and antiepileptic drugs with sodium channel-blocking properties were associated with out-of-hospital cardiac arrest, but these findings lacked replication.
Is epilepsy or the use of specific antiepileptic drugs associated with an increased risk of out-of-hospital cardiac arrest?
Case-Control (n=387,145)
Is epilepsy or the use of specific antiepileptic drugs associated with an increased risk of out-of-hospital cardiac arrest?
Hazard Ratio: 1.76 (95% CI 1.64–1.88)
Absolute Event Rate: 3.58% vs 1.6%
Epilepsy is associated with an increased risk of out-of-hospital cardiac arrest, but this risk does not appear to be driven by sodium channel-blocking antiepileptic drugs.
Epilepsy warrants heightened cardiac vigilance in practice; challenges prior sodium channel AED–OHCA links but leaves causality open in observational data.
AIMS: A few studies suggested that epilepsy and antiepileptic drugs with sodium channel-blocking properties were independently associated with out-of-hospital cardiac arrest (OHCA). However, these findings have not yet been replicated. METHODS: Using Danish registries, we conducted a nested case-control study in a cohort of individuals between 1 June 2001 and 31 December 2015. Cases were defined as OHCA from presumed cardiac causes, and were matched with non-OHCA-controls based on sex, and age on the date of OHCA. Exposure of interest was epilepsy or antiepileptic drug use. To study the association between individual antiepileptic drug use and the rate of OHCA, we compared each antiepileptic drug with valproic acid. Cox regression with time-dependent covariates was conducted to calculate hazard ratio (HR) and 95% confidence interval (CI). RESULTS: We identified 35 195 OHCA-cases and 351 950 matched non-OHCA controls. Epilepsy (cases: 3.58%, controls: 1.60%) was associated with increased rate of OHCA compared with the general population (HR: 1.76, 95%CI: 1.64-1.88) when common OHCA risk factors were taken into account. When we studied antiepileptic drug use, we found that 2 antiepileptic drugs without sodium channel blockage, clonazepam (HR: 1.88, 95%CI: 1.45-2.44) and pregabalin (HR: 1.33, 95%CI: 1.05-1.69), were associated with OHCA, whereas none of the antiepileptic drugs with sodium channel blockage were associated with OHCA. CONCLUSION: Epilepsy is associated with increased rate of OHCA. Our findings do not support a possible association between antiepileptic drugs with sodium channel-blocking properties and OHCA.
No takes yet. Share an insight, caveat, or question.
Eroglu et al. (2022) conducted a case-control in Out-of-hospital cardiac arrest (n=387,145). Epilepsy vs. General population was evaluated on Out-of-hospital cardiac arrest (HR 1.76, 95% CI 1.64-1.88). Epilepsy was associated with an increased rate of out-of-hospital cardiac arrest compared with the general population (HR 1.76; 95% CI 1.64-1.88).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: