Prevalence and associated factors of seizures and epilepsy in children with congenital heart disease: a systematic review and meta-analysis

Background Children with congenital heart disease (CHD) are vulnerable to acute symptomatic seizures and long-term epilepsy, but reported estimates vary across settings and outcome definitions. Methods PubMed/MEDLINE, Embase, Cochrane CENTRAL, and Web of Science were searched from inception until 3 June 2026. Observational studies reporting seizures or epilepsy in children with CHD were eligible. Random-effects models separately pooled logit-transformed prevalence estimates for long-term epilepsy and acute or early/in-hospital seizures. Odds ratios (ORs), mean differences (MDs), and standardized mean differences (SMDs) were pooled for associated factors. Risk of bias was appraised utilizing the Newcastle–Ottawa Scale (NOS). Results Ten studies were included, of which nine contributed binary prevalence data. Six studies comprising 50,563 participants and 1,228 cases were included in the primary analysis of long-term epilepsy. The pooled prevalence was 3.1% (95% CI, 2.2%−4.2%; I 2 = 75.3%). Three studies comprising 418,193 participants and 7,465 cases yielded a descriptive pooled estimate of 7.5% for acute or early/in-hospital seizures (95% CI, 1.4%−31.2%; I 2 = 99.4%), with limited generalizability across CHD populations. Factors associated with higher odds of seizures or epilepsy included neurological complications, extracorporeal membrane oxygenation (ECMO) use, single-ventricle physiology, delayed sternal closure, repeated cardiac surgery, and prematurity. Conclusions The available evidence suggests that children with CHD may experience clinically important burdens of acute seizures and long-term epilepsy. The observed associations may inform future studies of targeted neurological surveillance, but do not establish causal effects or surveillance benefits. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261397297 , identifier: CRD420261397297.