Cardiac arrhythmias in patients with focal and generalised epilepsy undergoing ambulatory electroencephalographic and electrocardiographic monitoring

Abstract

Background

Epilepsy may be associated with cardiac arrhythmias. The specific incidence and types of cardiac arrhythmias in different forms of epilepsy is not clearly defined.

Methods

We evaluated patients aged 16 years or older referred for continuous home-based ambulatory video–electroencephalographic(EEG)–electrocardiographic(ECG) monitoring (AVEEM) across 24 sites in Australia between 2020 and 2023. Data collected included baseline demographics, type of epilepsy according to EEG findings, and cardiac arrhythmias (ictal and non-ictal) during monitoring. Logistic regression was used to evaluate association between potential risk factors and cardiac arrhythmias.

Results

A total of 866 patients with focal epilepsy and 274 with generalised epilepsy were identified who underwent AVEEM. Patients with generalised epilepsy were younger (median age 24 years versus 43 years) and more likely female (69 % versus 55 %) compared with focal epilepsy. Patients with focal epilepsy had more cardiac arrhythmias (279/866; 32 %) compared with generalised epilepsy (40/274; 15 %; p = 0.04). In patients with focal epilepsy, there were more cardiac arrhythmias observed in temporal lobe epilepsy (238/688; 35 %) compared with extra-temporal lobe focal epilepsy (16/82; 20 %; p = 0.006). However, on multivariable analysis only increased age (p < 0.001) remained a significant predictor of increased cardiac arrhythmias. Right or left sided origin of focal epilepsy was not associated with a difference in cardiac arrhythmias (p = 0.63).

Conclusions

Patients with focal epilepsy had more cardiac arrhythmias compared with generalised epilepsy that was explained by increased age. This study demonstrates feasibility of longer term ambulatory EEG-ECG monitoring in the outpatient setting for real-world assessment of cardiac arrhythmias in patients with epilepsy.