Department of Cardiac Rhythm and Conduction Disturbances, National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia.
Department of Cardiac Rhythm and Conduction Disturbances, National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia.
Heart Rhythm. 2021 Feb;18(2):221-228. doi: 10.1016/j.hrthm.2020.09.002. Epub 2020 Sep 8.
Cardiac rhythm and conduction disorders are common in patients with epilepsy and are presumably one of the leading causes of sudden unexpected death. There are only a few published reports on ictal cardiac arrhythmias detected by continuous monitoring, and the majority had a small sample size.
The aim of this study was to evaluate the frequency and type of cardiac arrhythmias recorded by an implantable loop recorder in patients with drug-resistant epilepsy.
We implanted a subcutaneous loop recorder to 193 patients with drug-resistant epilepsy. Automatic triggers to initiate cardiac rhythm recording were cardiac pauses of >3 seconds and any episodes of bradycardia (≤45 beats/min) or tachycardia (≥150 beats/min). Patients/relatives were instructed to begin peri-ictal rhythm recording by using an external activator device. The follow-up duration was 36 months, with scheduled follow-up visits every 3 months.
A total of 6494 electrocardiogram traces were recorded during the median follow-up of 36 months (interquartile range 3-36 months). Ictal heart rhythm and rate changes were detected in 143 patients (74%). The most common finding was ictal sinus tachycardia (66.8%). Sinus bradycardia was observed in 13 patients (6.7%). Three patients had clinically relevant cardiac pauses of >6 seconds, requiring permanent pacemaker implantation. Five patients (2.6%) died suddenly.
Ictal heart rhythm and rate changes occur in most of the patients with drug-resistant epilepsy. Clinically relevant cardiac events, related to ictal and postictal periods, are rare. No potentially malignant arrhythmias were detected in patients who died suddenly during the preceding follow-up period.
心律失常和传导障碍在癫痫患者中很常见，可能是导致意外猝死的主要原因之一。目前仅有少数关于连续监测下癫痫发作时心律失常的文献报道，且大多数研究的样本量较小。
本研究旨在评估植入式环路记录器在耐药性癫痫患者中记录的心律失常的频率和类型。
我们对 193 例耐药性癫痫患者植入了皮下环路记录器。自动触发记录心脏节律的原因是心脏停搏>3 秒以及任何心动过缓（≤45 次/分）或心动过速（≥150 次/分）发作。我们指导患者/家属使用外部激活装置开始发作间期的节律记录。随访时间为 36 个月，每 3 个月进行一次定期随访。
在中位数为 36 个月（四分位距 3-36 个月）的随访期间共记录了 6494 份心电图记录。在 143 例患者（74%）中检测到了癫痫发作时的心律和心率变化。最常见的发现是癫痫发作时窦性心动过速（66.8%）。窦性心动过缓见于 13 例患者（6.7%）。3 例患者出现了>6 秒的有临床意义的心脏停搏，需要植入永久性起搏器。5 例患者（2.6%）猝死。
大多数耐药性癫痫患者都会出现癫痫发作时的心律和心率变化。与发作期和发作后相关的有临床意义的心脏事件很少见。在之前的随访期间死亡的患者中未发现潜在恶性心律失常。
