Role of the Screening ECG in People with Epilepsy

Many studies have shown that people with epilepsy are at higher risk for sudden death than the general population. Many of these unexpected deaths are SUDEP but people with epilepsy may also be susceptible to sudden cardiac death and myocardial infarction (heart attack). 

Could some of these at-risk people be identified with a routine screening, 12-lead electrocardiogram (ECG)?

Review of Case Studies

In a population-based registry of sudden deaths where there was recorded cardiac arrhythmia (abnormal heart rhythms such as ventricular fibrillation or tachycardia), there were 18 confirmed deaths in people with epilepsy. Often these cardiac deaths, like sudden cardiac deaths in the general population, are due to heart attack. But people with epilepsy appear to have genetic, congenital, or structural causes of cardiac death more often than matched controls (people without epilepsy). An ECG could identify some of these abnormalities and lead to specific interventions.

Several case series performing molecular autopsy (research that looks at cells in the body after a person dies) in SUDEP have identified mutations or changes in genes that are associated with cardiac arrhythmias such as long-QT syndromes, catecholaminergic polymorphic ventricular tachycardia, and Brugada syndrome in a significant minority of cases. These disorders are associated with changes that can be seen on a 12-lead ECG. Often there are ways to treat these heart conditions, such as avoiding certain medications or use of an implantable cardiac defibrillator.

Finally, epidemiological studies (studies in large groups of people) have shown that people with epilepsy have higher rates of cardiovascular disease than the general population. This may be due to risk factors – atherosclerosis can lead to epilepsy following a stroke as well as heart disease. There is also a suggestion that some anti-seizure medications may lead to atherosclerosis and heart disease by interfering with cholesterol metabolism. An ECG may identify people with epilepsy with silent coronary artery disease who may require further intervention to reduce their risks of heart attack or heart failure.

What does this mean for people with epilepsy?

• 12-lead ECG may be a low cost and effective test to help reduce mortality or death in people with epilepsy.
• More studies are needed to determine the risks, benefits, and costs associated with regular screening with routine ECG in all people with epilepsy.