钠通道拮抗剂抗癫痫药物所致心脏传导延迟：加拿大衰老纵向研究分析
Cardiac Conduction Delay for Sodium Channel Antagonist Antiseizure Medications: An Analysis of the Canadian Longitudinal Study on Aging.
作者信息
Shlobin Nathan A, Li Jimmy, Sander Josemir W, Keezer Mark Robert, Thijs Roland D
机构信息
Department of Neurosurgery, Neurological Institute of New York, New York Presbyterian Hospital-Columbia University Medical Center, NY.
Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands.
出版信息
Neurology. 2025 Feb 25;104(4):e210302. doi: 10.1212/WNL.0000000000210302. Epub 2025 Feb 3.
BACKGROUND AND OBJECTIVES
People with epilepsy are at risk of cardiac arrhythmias. Whether this association results from epilepsy, antiseizure medications (ASMs) such as sodium channel blockers (NABs), or other factors has not been systematically assessed. The aims of this study were to quantify the odds of cardiac conduction delays (CCDs) on electrocardiogram in older people with active epilepsy using vs not using NABs, to determine the prevalence of CCDs by NABs, and to examine the association of demographic and clinical factors with CCDs.
METHODS
This was a cross-sectional study of the Canadian Longitudinal Study on Aging. We defined active epilepsy as self-reported epilepsy and taking ASM. Sodium channel blockers (NABs) were phenytoin, lamotrigine, carbamazepine, oxcarbazepine, or lacosamide. We compared CCDs between people with epilepsy using NABs and those not using NABs; determined the prevalence of CCDs by NAB type; and fitted a logistic regression model for each abnormal ECG outcome as a function of active epilepsy and NAB use while adjusting for demographics and clinical factors. Multiple imputations handled missing data (200 iterations).
RESULTS
In total, 30,077 people, with mean age 63.0 (10.25) years and 50.9% female, were studied, including 141 people with active epilepsy who used NABs, 68 who did not use NABs, and 29,868 who did not have active epilepsy. Demographics between groups and relative to people without epilepsy were similar. People with active epilepsy taking NABs were more likely to have prolonged QRS (odds ratio [OR] = 2.85 [95% CI 1.09-7.43]) and any CCD (1.94 [1.03-3.63]) compared with those with active epilepsy without NAB. After adjusting for Framingham score and heart rate-lowering medications, NAB use was associated with prolonged QTc (OR = 1.52 [95% CI 1.06-2.18]) and any CCD (1.78 [1.16, 2.74]). The prevalence of any CCD was 36.1% [95% CI 24.2%-49.4%] for carbamazepine, 45.5% [31.7%-58.5%] for phenytoin, and 54.7% [28.9%-75.6%] lamotrigine. Epilepsy was not associated with any CCD.
DISCUSSION
People with active epilepsy using NABs more commonly have CCDs. NAB use is associated with CCD, whereas active epilepsy is not.
背景与目的
癫痫患者存在心律失常风险。这种关联是由癫痫本身、抗癫痫药物（ASMs）如钠通道阻滞剂（NABs）还是其他因素导致的，尚未得到系统评估。本研究的目的是量化使用与未使用NABs的老年活动性癫痫患者心电图上心脏传导延迟（CCDs）的比值比，确定不同NABs导致CCDs的患病率，并研究人口统计学和临床因素与CCDs的关联。
方法
这是一项关于加拿大衰老纵向研究的横断面研究。我们将活动性癫痫定义为自我报告有癫痫且正在服用ASM。钠通道阻滞剂（NABs）包括苯妥英、拉莫三嗪、卡马西平、奥卡西平或拉科酰胺。我们比较了使用NABs的癫痫患者和未使用NABs的癫痫患者之间的CCDs情况；按NAB类型确定CCDs的患病率；并针对每项异常心电图结果拟合一个逻辑回归模型，将其作为活动性癫痫和NAB使用情况的函数，同时调整人口统计学和临床因素。采用多次插补法处理缺失数据（200次迭代）。
结果
总共研究了30077人，平均年龄63.0（10.25）岁，女性占50.9%，其中包括141名使用NABs的活动性癫痫患者、68名未使用NABs的活动性癫痫患者以及29868名无活动性癫痫的人。各组之间以及与无癫痫者相比，人口统计学特征相似。与未使用NABs的活动性癫痫患者相比，使用NABs的活动性癫痫患者更易出现QRS间期延长（比值比[OR]=2.85[95%置信区间1.09 - 7.43]）和任何CCDs（1.94[1.03 - 3.63]）。在调整弗雷明汉评分和降低心率的药物后，使用NABs与QTc间期延长（OR = 1.52[95%置信区间1.06 - 2.18]）和任何CCDs（1.78[1.16, 2.74]）相关。卡马西平导致任何CCDs的患病率为36.1%[95%置信区间24.2% - 49.4%]，苯妥英为45.5%[31.7% - 58.5%]，拉莫三嗪为54.7%[28.9% - 75.6%]。癫痫与任何CCDs无关。
讨论
使用NABs的活动性癫痫患者更常出现CCDs。使用NABs与CCDs相关，而活动性癫痫本身则无关。
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