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Sivathamboo S, Liu Z, Sutherland F, Minato E, Casillas-Espinosa P, Jones NC, Todaro M, Seneviratne U, Cahill V, Yerra R, French C, Nicolo JP, Perucca P, Kwan P, Sparks P, O'Brien TJ. Serious Cardiac Arrhythmias Detected by Subcutaneous Long-term Cardiac Monitors in Patients With Drug-Resistant Epilepsy. Neurology 2022; 98:e1923-e1932. [PMID: 35387849 DOI: 10.1212/wnl.0000000000200173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 01/21/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Epilepsy is associated with an increased risk of cardiovascular disease and premature mortality, including sudden unexpected death in epilepsy (SUDEP). Serious cardiac arrythmias might go undetected in routine epilepsy and cardiac investigations. METHODS This prospective cohort study aimed to detect cardiac arrhythmias in patients with chronic drug-resistant epilepsy (≥5 years duration) using subcutaneous cardiac monitors for a minimum follow-up duration of 12 months. Participants with known cardiovascular disease or those with abnormal 12-lead ECGs were excluded. The device was programmed to automatically record episodes of tachycardia ≥140 beats per minute (bpm), bradycardia ≤40 bpm for ≥3 seconds, or asystole ≥3 seconds. FINDINGS Thirty-one patients underwent subcutaneous cardiac monitoring for a median recording duration of 2.2 years (range 0.5-4.2). During this time, 28 patients (90.3%) had episodes of sustained (≥30 seconds) sinus tachycardia, 8/31 (25.8%) had sinus bradycardia, and 3 (9.7%) had asystole. Three patients (9.7%) had serious cardiac arrhythmias requiring additional cardiac interventions. Among them, 2 patients had prolonged sinus arrest and ventricular asystole (>6 seconds), leading to pacemaker insertion in one, and another patient with epileptic encephalopathy had multiple episodes of recurrent nonsustained polymorphic ventricular tachycardia and bundle branch conduction abnormalities. The time to first detection of a clinically significant cardiac arrhythmia ranged between 1.2 and 26.9 months following cardiac monitor insertion. DISCUSSION Implantable cardiac monitors detected a high incidence of clinically significant cardiac arrhythmias in patients with chronic drug-resistant epilepsy, which may contribute to the incidence of premature mortality, including SUDEP.
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Affiliation(s)
- Shobi Sivathamboo
- From the Department of Neuroscience, Central Clinical School (S.S., Z.L., P.C.-E., N.C.J., M.T., C.F., J.-P.N., P.P., P.K., T.J.O.), Monash University; Department of Neurology (S.S., P.C.-E., N.C.J., M.T., J.-P.N., P.P., P.K., T.J.O.), The Alfred Hospital, Melbourne; Department of Medicine (S.S., P.C.-E., N.C.J., M.T., V.C., R.Y., C.F., J.-P.N., P.K., T.J.O.), The Royal Melbourne Hospital, The University of Melbourne; Departments of Neurology (S.S., F.S., M.T., V.C., R.Y., C.F., J.-P.N., P.P., P.K., T.J.O.) and Cardiology (F.S., P.S.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.M., U.S.), Monash Medical Centre, Clayton, Australia; Academic Neurology Unit (V.C.), Royal Hallamshire Hospital, University of Sheffield, Division of Neuroscience and Experimental Psychology (V.C.), School of Biological Sciences, University of Manchester, UK; Department of Medicine (P.P.), Austin Hospital, The University of Melbourne; and Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Austin Health, Heidelberg, Australia
| | - Zining Liu
- From the Department of Neuroscience, Central Clinical School (S.S., Z.L., P.C.-E., N.C.J., M.T., C.F., J.-P.N., P.P., P.K., T.J.O.), Monash University; Department of Neurology (S.S., P.C.-E., N.C.J., M.T., J.-P.N., P.P., P.K., T.J.O.), The Alfred Hospital, Melbourne; Department of Medicine (S.S., P.C.-E., N.C.J., M.T., V.C., R.Y., C.F., J.-P.N., P.K., T.J.O.), The Royal Melbourne Hospital, The University of Melbourne; Departments of Neurology (S.S., F.S., M.T., V.C., R.Y., C.F., J.-P.N., P.P., P.K., T.J.O.) and Cardiology (F.S., P.S.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.M., U.S.), Monash Medical Centre, Clayton, Australia; Academic Neurology Unit (V.C.), Royal Hallamshire Hospital, University of Sheffield, Division of Neuroscience and Experimental Psychology (V.C.), School of Biological Sciences, University of Manchester, UK; Department of Medicine (P.P.), Austin Hospital, The University of Melbourne; and Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Austin Health, Heidelberg, Australia
| | - Fiona Sutherland
- From the Department of Neuroscience, Central Clinical School (S.S., Z.L., P.C.-E., N.C.J., M.T., C.F., J.-P.N., P.P., P.K., T.J.O.), Monash University; Department of Neurology (S.S., P.C.-E., N.C.J., M.T., J.-P.N., P.P., P.K., T.J.O.), The Alfred Hospital, Melbourne; Department of Medicine (S.S., P.C.-E., N.C.J., M.T., V.C., R.Y., C.F., J.-P.N., P.K., T.J.O.), The Royal Melbourne Hospital, The University of Melbourne; Departments of Neurology (S.S., F.S., M.T., V.C., R.Y., C.F., J.-P.N., P.P., P.K., T.J.O.) and Cardiology (F.S., P.S.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.M., U.S.), Monash Medical Centre, Clayton, Australia; Academic Neurology Unit (V.C.), Royal Hallamshire Hospital, University of Sheffield, Division of Neuroscience and Experimental Psychology (V.C.), School of Biological Sciences, University of Manchester, UK; Department of Medicine (P.P.), Austin Hospital, The University of Melbourne; and Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Austin Health, Heidelberg, Australia
| | - Erica Minato
- From the Department of Neuroscience, Central Clinical School (S.S., Z.L., P.C.-E., N.C.J., M.T., C.F., J.-P.N., P.P., P.K., T.J.O.), Monash University; Department of Neurology (S.S., P.C.-E., N.C.J., M.T., J.-P.N., P.P., P.K., T.J.O.), The Alfred Hospital, Melbourne; Department of Medicine (S.S., P.C.-E., N.C.J., M.T., V.C., R.Y., C.F., J.-P.N., P.K., T.J.O.), The Royal Melbourne Hospital, The University of Melbourne; Departments of Neurology (S.S., F.S., M.T., V.C., R.Y., C.F., J.-P.N., P.P., P.K., T.J.O.) and Cardiology (F.S., P.S.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.M., U.S.), Monash Medical Centre, Clayton, Australia; Academic Neurology Unit (V.C.), Royal Hallamshire Hospital, University of Sheffield, Division of Neuroscience and Experimental Psychology (V.C.), School of Biological Sciences, University of Manchester, UK; Department of Medicine (P.P.), Austin Hospital, The University of Melbourne; and Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Austin Health, Heidelberg, Australia
| | - Pablo Casillas-Espinosa
- From the Department of Neuroscience, Central Clinical School (S.S., Z.L., P.C.-E., N.C.J., M.T., C.F., J.-P.N., P.P., P.K., T.J.O.), Monash University; Department of Neurology (S.S., P.C.-E., N.C.J., M.T., J.-P.N., P.P., P.K., T.J.O.), The Alfred Hospital, Melbourne; Department of Medicine (S.S., P.C.-E., N.C.J., M.T., V.C., R.Y., C.F., J.-P.N., P.K., T.J.O.), The Royal Melbourne Hospital, The University of Melbourne; Departments of Neurology (S.S., F.S., M.T., V.C., R.Y., C.F., J.-P.N., P.P., P.K., T.J.O.) and Cardiology (F.S., P.S.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.M., U.S.), Monash Medical Centre, Clayton, Australia; Academic Neurology Unit (V.C.), Royal Hallamshire Hospital, University of Sheffield, Division of Neuroscience and Experimental Psychology (V.C.), School of Biological Sciences, University of Manchester, UK; Department of Medicine (P.P.), Austin Hospital, The University of Melbourne; and Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Austin Health, Heidelberg, Australia
| | - Nigel C Jones
- From the Department of Neuroscience, Central Clinical School (S.S., Z.L., P.C.-E., N.C.J., M.T., C.F., J.-P.N., P.P., P.K., T.J.O.), Monash University; Department of Neurology (S.S., P.C.-E., N.C.J., M.T., J.-P.N., P.P., P.K., T.J.O.), The Alfred Hospital, Melbourne; Department of Medicine (S.S., P.C.-E., N.C.J., M.T., V.C., R.Y., C.F., J.-P.N., P.K., T.J.O.), The Royal Melbourne Hospital, The University of Melbourne; Departments of Neurology (S.S., F.S., M.T., V.C., R.Y., C.F., J.-P.N., P.P., P.K., T.J.O.) and Cardiology (F.S., P.S.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.M., U.S.), Monash Medical Centre, Clayton, Australia; Academic Neurology Unit (V.C.), Royal Hallamshire Hospital, University of Sheffield, Division of Neuroscience and Experimental Psychology (V.C.), School of Biological Sciences, University of Manchester, UK; Department of Medicine (P.P.), Austin Hospital, The University of Melbourne; and Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Austin Health, Heidelberg, Australia
| | - Marian Todaro
- From the Department of Neuroscience, Central Clinical School (S.S., Z.L., P.C.-E., N.C.J., M.T., C.F., J.-P.N., P.P., P.K., T.J.O.), Monash University; Department of Neurology (S.S., P.C.-E., N.C.J., M.T., J.-P.N., P.P., P.K., T.J.O.), The Alfred Hospital, Melbourne; Department of Medicine (S.S., P.C.-E., N.C.J., M.T., V.C., R.Y., C.F., J.-P.N., P.K., T.J.O.), The Royal Melbourne Hospital, The University of Melbourne; Departments of Neurology (S.S., F.S., M.T., V.C., R.Y., C.F., J.-P.N., P.P., P.K., T.J.O.) and Cardiology (F.S., P.S.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.M., U.S.), Monash Medical Centre, Clayton, Australia; Academic Neurology Unit (V.C.), Royal Hallamshire Hospital, University of Sheffield, Division of Neuroscience and Experimental Psychology (V.C.), School of Biological Sciences, University of Manchester, UK; Department of Medicine (P.P.), Austin Hospital, The University of Melbourne; and Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Austin Health, Heidelberg, Australia
| | - Udaya Seneviratne
- From the Department of Neuroscience, Central Clinical School (S.S., Z.L., P.C.-E., N.C.J., M.T., C.F., J.-P.N., P.P., P.K., T.J.O.), Monash University; Department of Neurology (S.S., P.C.-E., N.C.J., M.T., J.-P.N., P.P., P.K., T.J.O.), The Alfred Hospital, Melbourne; Department of Medicine (S.S., P.C.-E., N.C.J., M.T., V.C., R.Y., C.F., J.-P.N., P.K., T.J.O.), The Royal Melbourne Hospital, The University of Melbourne; Departments of Neurology (S.S., F.S., M.T., V.C., R.Y., C.F., J.-P.N., P.P., P.K., T.J.O.) and Cardiology (F.S., P.S.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.M., U.S.), Monash Medical Centre, Clayton, Australia; Academic Neurology Unit (V.C.), Royal Hallamshire Hospital, University of Sheffield, Division of Neuroscience and Experimental Psychology (V.C.), School of Biological Sciences, University of Manchester, UK; Department of Medicine (P.P.), Austin Hospital, The University of Melbourne; and Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Austin Health, Heidelberg, Australia
| | - Varduhi Cahill
- From the Department of Neuroscience, Central Clinical School (S.S., Z.L., P.C.-E., N.C.J., M.T., C.F., J.-P.N., P.P., P.K., T.J.O.), Monash University; Department of Neurology (S.S., P.C.-E., N.C.J., M.T., J.-P.N., P.P., P.K., T.J.O.), The Alfred Hospital, Melbourne; Department of Medicine (S.S., P.C.-E., N.C.J., M.T., V.C., R.Y., C.F., J.-P.N., P.K., T.J.O.), The Royal Melbourne Hospital, The University of Melbourne; Departments of Neurology (S.S., F.S., M.T., V.C., R.Y., C.F., J.-P.N., P.P., P.K., T.J.O.) and Cardiology (F.S., P.S.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.M., U.S.), Monash Medical Centre, Clayton, Australia; Academic Neurology Unit (V.C.), Royal Hallamshire Hospital, University of Sheffield, Division of Neuroscience and Experimental Psychology (V.C.), School of Biological Sciences, University of Manchester, UK; Department of Medicine (P.P.), Austin Hospital, The University of Melbourne; and Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Austin Health, Heidelberg, Australia
| | - Raju Yerra
- From the Department of Neuroscience, Central Clinical School (S.S., Z.L., P.C.-E., N.C.J., M.T., C.F., J.-P.N., P.P., P.K., T.J.O.), Monash University; Department of Neurology (S.S., P.C.-E., N.C.J., M.T., J.-P.N., P.P., P.K., T.J.O.), The Alfred Hospital, Melbourne; Department of Medicine (S.S., P.C.-E., N.C.J., M.T., V.C., R.Y., C.F., J.-P.N., P.K., T.J.O.), The Royal Melbourne Hospital, The University of Melbourne; Departments of Neurology (S.S., F.S., M.T., V.C., R.Y., C.F., J.-P.N., P.P., P.K., T.J.O.) and Cardiology (F.S., P.S.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.M., U.S.), Monash Medical Centre, Clayton, Australia; Academic Neurology Unit (V.C.), Royal Hallamshire Hospital, University of Sheffield, Division of Neuroscience and Experimental Psychology (V.C.), School of Biological Sciences, University of Manchester, UK; Department of Medicine (P.P.), Austin Hospital, The University of Melbourne; and Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Austin Health, Heidelberg, Australia
| | - Christopher French
- From the Department of Neuroscience, Central Clinical School (S.S., Z.L., P.C.-E., N.C.J., M.T., C.F., J.-P.N., P.P., P.K., T.J.O.), Monash University; Department of Neurology (S.S., P.C.-E., N.C.J., M.T., J.-P.N., P.P., P.K., T.J.O.), The Alfred Hospital, Melbourne; Department of Medicine (S.S., P.C.-E., N.C.J., M.T., V.C., R.Y., C.F., J.-P.N., P.K., T.J.O.), The Royal Melbourne Hospital, The University of Melbourne; Departments of Neurology (S.S., F.S., M.T., V.C., R.Y., C.F., J.-P.N., P.P., P.K., T.J.O.) and Cardiology (F.S., P.S.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.M., U.S.), Monash Medical Centre, Clayton, Australia; Academic Neurology Unit (V.C.), Royal Hallamshire Hospital, University of Sheffield, Division of Neuroscience and Experimental Psychology (V.C.), School of Biological Sciences, University of Manchester, UK; Department of Medicine (P.P.), Austin Hospital, The University of Melbourne; and Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Austin Health, Heidelberg, Australia
| | - John-Paul Nicolo
- From the Department of Neuroscience, Central Clinical School (S.S., Z.L., P.C.-E., N.C.J., M.T., C.F., J.-P.N., P.P., P.K., T.J.O.), Monash University; Department of Neurology (S.S., P.C.-E., N.C.J., M.T., J.-P.N., P.P., P.K., T.J.O.), The Alfred Hospital, Melbourne; Department of Medicine (S.S., P.C.-E., N.C.J., M.T., V.C., R.Y., C.F., J.-P.N., P.K., T.J.O.), The Royal Melbourne Hospital, The University of Melbourne; Departments of Neurology (S.S., F.S., M.T., V.C., R.Y., C.F., J.-P.N., P.P., P.K., T.J.O.) and Cardiology (F.S., P.S.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.M., U.S.), Monash Medical Centre, Clayton, Australia; Academic Neurology Unit (V.C.), Royal Hallamshire Hospital, University of Sheffield, Division of Neuroscience and Experimental Psychology (V.C.), School of Biological Sciences, University of Manchester, UK; Department of Medicine (P.P.), Austin Hospital, The University of Melbourne; and Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Austin Health, Heidelberg, Australia
| | - Piero Perucca
- From the Department of Neuroscience, Central Clinical School (S.S., Z.L., P.C.-E., N.C.J., M.T., C.F., J.-P.N., P.P., P.K., T.J.O.), Monash University; Department of Neurology (S.S., P.C.-E., N.C.J., M.T., J.-P.N., P.P., P.K., T.J.O.), The Alfred Hospital, Melbourne; Department of Medicine (S.S., P.C.-E., N.C.J., M.T., V.C., R.Y., C.F., J.-P.N., P.K., T.J.O.), The Royal Melbourne Hospital, The University of Melbourne; Departments of Neurology (S.S., F.S., M.T., V.C., R.Y., C.F., J.-P.N., P.P., P.K., T.J.O.) and Cardiology (F.S., P.S.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.M., U.S.), Monash Medical Centre, Clayton, Australia; Academic Neurology Unit (V.C.), Royal Hallamshire Hospital, University of Sheffield, Division of Neuroscience and Experimental Psychology (V.C.), School of Biological Sciences, University of Manchester, UK; Department of Medicine (P.P.), Austin Hospital, The University of Melbourne; and Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Austin Health, Heidelberg, Australia
| | - Patrick Kwan
- From the Department of Neuroscience, Central Clinical School (S.S., Z.L., P.C.-E., N.C.J., M.T., C.F., J.-P.N., P.P., P.K., T.J.O.), Monash University; Department of Neurology (S.S., P.C.-E., N.C.J., M.T., J.-P.N., P.P., P.K., T.J.O.), The Alfred Hospital, Melbourne; Department of Medicine (S.S., P.C.-E., N.C.J., M.T., V.C., R.Y., C.F., J.-P.N., P.K., T.J.O.), The Royal Melbourne Hospital, The University of Melbourne; Departments of Neurology (S.S., F.S., M.T., V.C., R.Y., C.F., J.-P.N., P.P., P.K., T.J.O.) and Cardiology (F.S., P.S.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.M., U.S.), Monash Medical Centre, Clayton, Australia; Academic Neurology Unit (V.C.), Royal Hallamshire Hospital, University of Sheffield, Division of Neuroscience and Experimental Psychology (V.C.), School of Biological Sciences, University of Manchester, UK; Department of Medicine (P.P.), Austin Hospital, The University of Melbourne; and Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Austin Health, Heidelberg, Australia
| | - Paul Sparks
- From the Department of Neuroscience, Central Clinical School (S.S., Z.L., P.C.-E., N.C.J., M.T., C.F., J.-P.N., P.P., P.K., T.J.O.), Monash University; Department of Neurology (S.S., P.C.-E., N.C.J., M.T., J.-P.N., P.P., P.K., T.J.O.), The Alfred Hospital, Melbourne; Department of Medicine (S.S., P.C.-E., N.C.J., M.T., V.C., R.Y., C.F., J.-P.N., P.K., T.J.O.), The Royal Melbourne Hospital, The University of Melbourne; Departments of Neurology (S.S., F.S., M.T., V.C., R.Y., C.F., J.-P.N., P.P., P.K., T.J.O.) and Cardiology (F.S., P.S.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.M., U.S.), Monash Medical Centre, Clayton, Australia; Academic Neurology Unit (V.C.), Royal Hallamshire Hospital, University of Sheffield, Division of Neuroscience and Experimental Psychology (V.C.), School of Biological Sciences, University of Manchester, UK; Department of Medicine (P.P.), Austin Hospital, The University of Melbourne; and Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Austin Health, Heidelberg, Australia
| | - Terence J O'Brien
- From the Department of Neuroscience, Central Clinical School (S.S., Z.L., P.C.-E., N.C.J., M.T., C.F., J.-P.N., P.P., P.K., T.J.O.), Monash University; Department of Neurology (S.S., P.C.-E., N.C.J., M.T., J.-P.N., P.P., P.K., T.J.O.), The Alfred Hospital, Melbourne; Department of Medicine (S.S., P.C.-E., N.C.J., M.T., V.C., R.Y., C.F., J.-P.N., P.K., T.J.O.), The Royal Melbourne Hospital, The University of Melbourne; Departments of Neurology (S.S., F.S., M.T., V.C., R.Y., C.F., J.-P.N., P.P., P.K., T.J.O.) and Cardiology (F.S., P.S.), The Royal Melbourne Hospital, Parkville; Department of Neurology (E.M., U.S.), Monash Medical Centre, Clayton, Australia; Academic Neurology Unit (V.C.), Royal Hallamshire Hospital, University of Sheffield, Division of Neuroscience and Experimental Psychology (V.C.), School of Biological Sciences, University of Manchester, UK; Department of Medicine (P.P.), Austin Hospital, The University of Melbourne; and Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Austin Health, Heidelberg, Australia
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