Background

Refractory epilepsy confers a considerable lifetime risk of sudden unexplained death in epilepsy (SUDEP). Mechanisms may overlap with sudden cardiac death (SCD), particularly regarding QTc prolongation. Guidelines in the United States do not mandate the use of electrocardiography (ECG) in diagnostic evaluation of seizures or epilepsy.

Objective

The purpose of this study was to determine the frequency of ECG use and of QT prolongation, and whether QT prolongation predicts mortality in patients with seizures.

Methods

We performed a retrospective cohort study including all patients seen at Mayo Clinic in Rochester, Minnesota, from January 1, 2000, to July 31, 2015, with index evaluation for seizure or epilepsy. Patients with an ECG were categorized by the presence of a prolonged QT interval with a primary endpoint of all-cause mortality after the 15-year observation period.

Results

Optimal cutoff QT intervals most predictive of mortality were identified. Median age was 40.0 years. An ECG was obtained in 18,222 patients (57.4%). After patients with confounding ECG findings were excluded, primary prolonged QT intervals were seen in 223 cases (1.4%), similar to the general population. Kaplan-Meier analysis demonstrated a significant increase in mortality (Cox hazard ratio [HR] 1.90; 95% confidence interval [CI] 1.76–2.05) for prolonged optimal cutoff QT, maintained after adjustments for age, Charlson comorbidity index, and sex (HR 1.48; 95% CI 1.37–1.59).

Conclusion

Use of ECG in diagnostic workup of patients with seizures is poor. A prolonged optimal cutoff QTc interval predicts all-cause mortality in patients evaluated for seizure and those diagnosed with epilepsy. We advocate the routine use of a 12-lead ECG at index evaluation in patients with seizure or epilepsy.

中文翻译：

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对癫痫发作或癫痫进行指数评估的患者的 QT 延长可预测全因死亡率

背景

难治性癫痫会带来相当大的终生不明原因猝死 (SUDEP) 风险。机制可能与心源性猝死 (SCD) 重叠，特别是在 QTc 延长方面。美国指南未强制要求使用心电图 (ECG) 对癫痫发作或癫痫进行诊断评估。

客观的

本研究的目的是确定心电图使用频率和 QT 间期延长，以及 QT 间期延长是否可以预测癫痫患者的死亡率。

方法

我们进行了一项回顾性队列研究，包括 2000 年 1 月 1 日至 2015 年 7 月 31 日期间在明尼苏达州罗切斯特的梅奥诊所就诊的所有患者，并对癫痫发作或癫痫进行指数评估。有 ECG 的患者根据是否存在 QT 间期延长进行分类，其主要终点是 15 年观察期后的全因死亡率。

结果

确定了最能预测死亡率的最佳截止 QT 间期。中位年龄为 40.0 岁。18,222 名患者 (57.4%) 获得了心电图。排除心电图结果混杂的患者后，223 例 (1.4%) 出现原发性 QT 间期延长，与一般人群相似。Kaplan-Meier 分析表明，延长最佳 QT 截止值会显着增加死亡率（Cox 风险比 [HR] 1.90；95% 置信区间 [CI] 1.76–2.05），并在针对年龄、Charlson 合并症指数和性别（HR）进行调整后保持不变1.48；95% CI 1.37–1.59）。

结论

ECG 在癫痫发作患者的诊断检查中的应用很差。延长的最佳截止 QTc 间期可预测评估为癫痫发作的患者和诊断为癫痫的患者的全因死亡率。我们提倡在癫痫发作或癫痫患者的指标评估中常规使用 12 导联心电图。