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Cardiac arrhythmias in epilepsy: Troublemaker, accomplice, or innocent bystander?

  • Julia C. Isbister
    Affiliations
    Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia

    Faculty of Medicine and Health, The University of Sydney, Sidney, Australia

    Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
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  • Raymond W. Sy
    Affiliations
    Faculty of Medicine and Health, The University of Sydney, Sidney, Australia

    Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
    Search for articles by this author
  • Christopher Semsarian
    Correspondence
    Address reprint requests and correspondence: Dr Christopher Semsarian, Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Locked Bag 6, Newtown, NSW 2042, Australia.
    Affiliations
    Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia

    Faculty of Medicine and Health, The University of Sydney, Sidney, Australia

    Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
    Search for articles by this author
Published:September 17, 2020DOI:https://doi.org/10.1016/j.hrthm.2020.09.008
      Patients with epilepsy experience an excess burden of morbidity and mortality. Premature death occurs at twice the rate expected for age, and sudden unexplained death in epilepsy (SUDEP) is the leading epilepsy-related cause of death.
      • Sillanpää M.
      • Shinnar S.
      Long-term mortality in childhood-onset epilepsy.
      Peri-ictal arrhythmias were first described in the late 19th and 20th centuries.
      • Russell A.
      Cessation of the pulse during the onset of epileptic fits: with remarks on the mechanism of fits.
      However, the clinical significance of heart rhythm disturbance in epilepsy and, in particular, their potential role in SUDEP remains unclear. Case reports and case series dominate the available literature, most commonly in the setting of inpatient video electroencephalography with the limitations of short-term monitoring as well as confounding factors such as antiarrhythmic drug withdrawal.
      • van der Lende M.
      • Surges R.
      • Sander J.W.
      • Thijs R.D.
      Cardiac arrhythmias during or after epileptic seizures.
      Long-term monitoring is needed to understand the clinical implications of rhythm disturbance in epilepsy.
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