Document Detail


Epileptic patients who survived sudden cardiac death have increased risk of recurrent arrhythmias and death.
MedLine Citation:
PMID:  20543707     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Cardiac arrhythmogenesis and cryptogenic epilepsy can be due to ion channel dysfunction and may coexist in the same patient. Sudden unexplained death in epilepsy (SUDEP) is a known entity with unknown cause, with the possibility of ventricular tachyarrhythmias being one of the causes. However, no prior study has investigated epileptic survivors of sudden cardiac death (SCD), recurrent life-threatening ventricular tachyarrhythmia (LTVA) and other outcomes in this patient population.
METHODS: The Antiarrhythmics Versus Implantable Cardioverter Defibrillators (AVID) Trial (n = 1016) was a multicenter trial comparing a cardioverter-defibrillator device (ICD) (n = 507) and anti-arrhythmic drugs (AADs) (n = 499) for secondary prevention of LTVAs. Mean follow-up duration was 916 ± 471 days per patient. Patients with a history of epilepsy (n = 6) in the ICD arm were included in this analysis. End points were recurrence of LTVA, cardiac death and all-cause mortality.
RESULTS: History of epilepsy (n = 6) was a significant predictor of recurrent LTVA [hazard ratio 3.53, 95% confidence interval (CI) 1.30-9.56], cardiac death (hazard ratio 4.14, 95% CI 1.30-13.14) and all-cause mortality (hazard ratio 3.82, 95% CI 1.40-10.48) in the ICD arm (n = 498). This relationship remained unchanged on multivariate analysis after controlling for baseline clinical differences.
CONCLUSION: This is the first study to investigate the effect of epilepsy on secondary prevention of LTVA. Epileptic survivors of SCD are at significantly greater risk of recurrent arrhythmias and death as compared to other survivors of recurrent LTVA. Role of coexisting channelopathies in both epilepsy and arrhythmogenesis may explain SUDEP and requires further investigation.
Authors:
Apurva Badheka; Ankit Rathod; Mohammad A Kizilbash; Zongshan Lai; Tamam Mohamad; Aashit Shah; Luis Afonso; Sony Jacob
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of cardiovascular medicine (Hagerstown, Md.)     Volume:  11     ISSN:  1558-2035     ISO Abbreviation:  J Cardiovasc Med (Hagerstown)     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-09-30     Completed Date:  2011-01-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101259752     Medline TA:  J Cardiovasc Med (Hagerstown)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  810-4     Citation Subset:  IM    
Affiliation:
Division of Cardiology/Electrophysiology, Department of Internal Medicine, Wayne State University, Detroit, Michigan 48201, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Anti-Arrhythmia Agents / therapeutic use*
Death, Sudden, Cardiac / etiology,  prevention & control*
Defibrillators, Implantable
Electric Countershock* / instrumentation
Epilepsy / complications*,  mortality
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Multicenter Studies as Topic
Proportional Hazards Models
Randomized Controlled Trials as Topic
Recurrence
Retrospective Studies
Risk Assessment
Risk Factors
Secondary Prevention / methods*
Tachycardia, Ventricular / etiology*,  mortality,  prevention & control
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anti-Arrhythmia Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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