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001 ABNORMALITIES IN CARDIAC RHYTHM REVEALED IN PATIENTS WITH REFRACTORY EPILEPSY
R. J. Simister, F. J. Rugg-Gunn, M. Squirrell, M. S. Hall, D. Holdright, J. S. Duncan. Department of Clinical and Experimental Epilepsy, Institute of Neurology, London; Department of Cardiology, Middlesex and Heart Hospitals, London; Medtronic Ltd, Watford
Background: In the United Kingdom over 500 deaths per year are attributable to sudden unexpected death in epilepsy (SUDEP). SUDEP may be caused by potentially avoidable fatal cardiac arrhythmias and asystole following seizures.
Methods: We implanted REVEAL Plus cardiac rhythm monitoring devices into 11 male and 8 female patients with severe focal epilepsy who had had diagnostic video and EEG. Each volunteer kept a prospective seizure diary and attended our clinic for regular downloading of the recorded cardiac rhythm data over a median 16 month period.
Results: In all patients habitual seizures were associated with increased heart rate. Six patients consistently recorded ictal heart rates of greater than 120 beats per minute (bpm). Ictal bradycardia (30 bpm) was observed in two patients and prolonged in one. Significant episodes of sino-atrial (SA) node arrest occurred in two patients and lasted five and 13 seconds respectively. The first occurred peri-ictally while in the second a seizure was not noted at the time. Permanent pacemaker insertion has since been performed in both these patients and is planned for the patient with the prolonged ictal bradycardia.
Conclusions: A potentially life-threatening cardiac rhythm abnormality was recorded in three of 19 patients, requiring permanent pacemaker insertion. These findings necessitate a profound re-evaluation of the role of long-term cardiac monitoring in patients with epilepsy.
002 THE VALUE OF THE ELECTROCARDIOGRAPH (ECG) IN A FIRST SEIZURE CLINIC
S. Wong, P. C. Adams, M. J. Jackson. Dept Cardiology & Neurology, Royal Victoria Infirmary, Newcastle upon Tyne
Current guidelines recommend recording a standard 12 lead ECG in patients presenting with suspected seizures. The yield from this investigation is unknown. We reviewed 163 (of 164) consecutive …