Department of Neurology, University of Massachusetts Medical School, 55 Lake Ave N, Worcester, MA 01655, USA.
Department of Neurology, Montefiore Medical Center and Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467, USA.
Epilepsy Behav. 2021 Jul;120:107998. doi: 10.1016/j.yebeh.2021.107998. Epub 2021 May 12.
To determine if Emergency Department (ED) or inpatient encounters for epilepsy or status epilepticus are associated with increased odds of cardiac arrhythmia or cardiac arrest over successively longer time frames.
The State Inpatient and ED Databases (from New York, Florida, and California) are statewide datasets containing data on 97% of hospitalizations and ED encounters from these states. In this retrospective, case-crossover study, we used International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify index cardiac arrhythmia encounters. Exposures were inpatient or ED encounters for epilepsy or status epilepticus. The case-crossover analysis tested whether an epilepsy or status epilepticus encounter within various case periods (1, 3, 7, 30, 60, 90, and 180 days prior to index encounter) was associated with subsequent ED or inpatient encounter for cardiac arrhythmia, as compared to control periods of equal length one year prior.
The odds ratio (OR) for cardiac arrhythmia after an epilepsy encounter was significant at all time intervals (OR range 2.37-3.36), and highest at 1 day after epilepsy encounter (OR 3.63, 95% confidence interval [CI] 1.66-7.93, p = 0.0013). The OR after status epilepticus was significant at 7- to 180-day intervals (OR range 2.25-2.74), and highest at 60 days (OR 2.74, CI 2.09-3.61, p < 0.0001).
Epilepsy and status epilepticus events are associated with increased odds of subsequent cardiac arrhythmia or cardiac arrest over multiple chronic timeframes. Increased cardiac surveillance may be warranted to minimize morbidity and mortality in patients with epilepsy.
确定癫痫或癫痫持续状态的急诊科（ED）或住院患者就诊是否与心律失常或心脏骤停的发生风险增加相关，这种风险随时间推移而逐渐增加。
州内住院患者和 ED 数据库（来自纽约、佛罗里达和加利福尼亚）是全州范围内的数据集，包含这些州的 97%的住院患者和 ED 就诊的数据。在这项回顾性病例交叉研究中，我们使用国际疾病分类第 9 版临床修订版（ICD-9-CM）代码来确定心律失常的索引事件。暴露因素为癫痫或癫痫持续状态的住院或 ED 就诊。病例交叉分析测试了在各种病例期（索引事件前 1、3、7、30、60、90 和 180 天）内的癫痫或癫痫持续状态就诊是否与随后的心律失常 ED 或住院患者就诊相关，与一年前相同长度的对照期相比。
癫痫发作后心律失常的比值比（OR）在所有时间间隔均具有统计学意义（OR 范围为 2.37-3.36），在癫痫发作后 1 天最高（OR 3.63，95%置信区间 [CI] 1.66-7.93，p=0.0013）。癫痫持续状态后的 OR 在 7 至 180 天间隔具有统计学意义（OR 范围为 2.25-2.74），在 60 天最高（OR 2.74，CI 2.09-3.61，p<0.0001）。
癫痫和癫痫持续状态事件与多个慢性时间段内心律失常或心脏骤停的发生风险增加相关。可能需要增加心脏监测，以最大限度地降低癫痫患者的发病率和死亡率。
