Subscribe to RSS
Routine Interictal EEG Recording Should be Performed Together with Simultaneous Two-Lead ECG RecordingFunding None.
We aimed to evaluate the contribution of simultaneous electrocardiography (ECG) recording during routine interictal electroencephalography (EEG) recording in patients with seizures or epilepsy and therefore to provide evidence-based data on this subject. Patients with interictal cardiac arrhythmia on routine EEG-ECG recordings were determined and evaluated based on cardiologic and neurologic findings. Out of 1,078 patients aged between 5 and 16 years (mean: 10.2 ± 3.2), 9 (0.08%) patients were found to have an arrhythmia. Six patients had both epilepsy and cardiac arrhythmia (premature ventricular contractions [PVCs] in 5; Wolff-Parkinson-White [WPW] in 1 patient) and the remaining three patients had nonepileptic paroxysmal events (NPEs) and arrhythmia (PVC in 2; WPW in 1). Three patients had other diseases (neurofibromatosis type 1, tuberous sclerosis, and congenital heart disease status postsurgery). Cardiac arrhythmia required radiofrequency ablation or antiarrhythmic drug treatment in two patients with epilepsy and also two patients with NPE; however, it improved with no specific treatment in the remaining five patients. NPE was not related to arrhythmia in one of three patients with NPE. Our study suggests that routine interictal EEG-ECG recording provides a valuable and feasible opportunity to reveal unnoticed or new-onset cardiac arrhythmias. Therefore, ECG should be recorded simultaneously during routine interictal EEG recordings. Cardiac arrhythmias detected by routine interictal EEG-ECG recordings would require arrhythmia treatment in nearly half of the patients.
Keywordsarrhythmia - nonepileptic paroxysmal events - electroencephalography - electrocardiography - epilepsy - seizure - children
All procedures performed in this study were following the ethical standards of the Institutional Research Committee and with the 1964 Helsinki Declaration and its comparable ethical standards.
K.Y. made the concept and design of the study. All authors contributed to the patient enrolment and collection of samples. K.Y. wrote the article after all of the authors participated in the interpretation of the data. After all of the authors reviewed the manuscript and decided to submit it for publication, the article was corresponded by K.Y. All authors participated in the final edited version of the article. All authors will act as guarantors for the paper.
Received: 25 November 2021
Accepted: 26 May 2022
Article published online:
02 August 2022
© 2022. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Parisi P, Oliva A, Coll Vidal M. et al. Coexistence of epilepsy and Brugada syndrome in a family with SCN5A mutation. Epilepsy Res 2013; 105 (03) 415-418
- 2 Anderson JH, Bos JM, Cascino GD, Ackerman MJ. Prevalence and spectrum of electroencephalogram-identified epileptiform activity among patients with long QT syndrome. Heart Rhythm 2014; 11 (01) 53-57
- 3 M. Ramadan M, El-Shahat N, A. Omar A. et al. Interictal electrocardiographic and echocardiographic changes in patients with generalized tonic-clonic seizures. Int Heart J 2013; 54 (03) 171-175
- 4 Zaccara G, Lattanzi S. Comorbidity between epilepsy and cardiac arrhythmias: implication for treatment. Epilepsy Behav 2019; 97: 304-312
- 5 Li MCH, O'Brien TJ, Todaro M, Powell KL. Acquired cardiac channelopathies in epilepsy: evidence, mechanisms, and clinical significance. Epilepsia 2019; 60 (09) 1753-1767
- 6 Ravindran K, Powell KL, Todaro M, O'Brien TJ. The pathophysiology of cardiac dysfunction in epilepsy. Epilepsy Res 2016; 127: 19-29
- 7 Pitney MR, Beran RG, Jones A. A simultaneous electrocardiogram is important when electroencephalography is used in the evaluation of loss of consciousness. Electroencephalogr Clin Neurophysiol 1994; 90 (03) 246-248
- 8 Kendirli MT, Aparci M, Kendirli N. et al. Diagnostic role of ECG recording simultaneously with EEG testing. Clin EEG Neurosci 2015; 46 (03) 214-217
- 9 Kim SH, Kim H, Lim BC. et al. Paroxysmal nonepileptic events in pediatric patients confirmed by long-term video-EEG monitoring–single tertiary center review of 143 patients. Epilepsy Behav 2012; 24 (03) 336-340
- 10 Onder H, Tezer I, Hekimsoy V, Saygi S. Simultaneous electrocardiogram during routine electroencephalogram: arrhythmia rates through the eyes of the cardiologist. Arq Neuropsiquiatr 2021; 79 (01) 15-21
- 11 Yassin A, El-Salem K, Khassawneh BY. et al. Diagnostic value of electrocardiogram during routine electroencephalogram. Seizure 2021; 89: 19-23
- 12 Walsh EP, Berul CI, Triedman JK. Cardiac arrhythmias. In: Keane JF, Lock JE, Fyler DC. eds. Nadas' Pediatric Cardiology. Philadelphia: Saunders Elsevier; 2006: 477-524
- 13 Munger TM, Packer DL, Hammill SC. et al. A population study of the natural history of Wolff-Parkinson-White syndrome in Olmsted County, Minnesota, 1953-1989. Circulation 1993; 87 (03) 866-873
- 14 Kim SS, Knight BP. Long term risk of Wolff-Parkinson-White pattern and syndrome. Trends Cardiovasc Med 2017; 27 (04) 260-268
- 15 Raposo D, António N, Andrade H, Sousa P, Pires A, Gonçalves L. Management of asymptomatic Wolff-Parkinson-White pattern in young patients: has anything changed?. Pediatr Cardiol 2019; 40 (05) 892-900
- 16 Dagar S, Emektar E, Corbacioglu SK, Demirci OL, Tandogan M, Cevik Y. Evaluation of electrocardiographic parameters in patients with epileptic seizure. Acta Neurol Belg 2020; 120 (02) 321-327
- 17 Ruthirago D, Julayanont P, Karukote A, Shehabeldin M, Nugent K. Sudden unexpected death in epilepsy: ongoing challenges in finding mechanisms and prevention. Int J Neurosci 2018; 128 (11) 1052-1060