ECG指标可能提示癫痫患者有发生心搏骤停的风险

一项对心电图记录的横断面、回顾性分析显示，与对照相比，难治性癫痫患者中更常见重度QTc间期延长和早期复极心电图改变（ERP）。

近期数据显示，癫痫患者的心搏骤停（SCA）风险增加1-2倍 ，并且已知重度QTc间期延长和ERP是一般人群中SCA的风险指标。

为了进一步探讨癫痫患者与SCA风险增高之间的关系，进行了这项研究。该研究结果显示，在185例药物难治性癫痫患者中，5%的ECG记录中出现重度QTc延长，而178例无癫痫对照中无一出现重度QTc间期延长，患者和对照组分别有34%和13%出现ERP。经校正癫痫、性别、年龄和心率后，发现癫痫仍与重度QTc间期延长［比值比（OR）为9.9］和ERP（OR为2.4）保持相关性，荷兰海姆斯泰德市荷兰癫痫基金会研究院的Robert J. Lamberts博士说(J. Neurol. Neurosurg. Psychiatry 2014 June 19 [doi:10.1136/jnnp-2014-307772])。

研究结论为，ECG出现重度QTc间期延长和ERP可能提示癫痫患者有发生心搏骤停的风险。对于癫痫患者，应常规进行ECG评估，这对指导临床医生选择癫痫药物治疗具有重要意义，如对于有提示SCA风险增高的ECG指标的患者，应避免使用延长QT间期或阻断去极化的药物。

该研究由荷兰癫痫基金会、基督教癫痫患者护理协会和荷兰科学研究组织资助。Lamberts博士披露无相关利益冲突。合著者披露与癫痫协会、Marvin Weil医生癫痫研究基金、卫材公司、葛兰素史克公司、UCB制药公司、世界卫生组织、美国国立卫生研究院、NutsOhra基金、美敦力公司、AC Thomson基金会、瑞士国家科学基金会和SICPA基金会之间存在利益关系。

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Severe QTc prolongation and early repolarization pattern on electrocardiogram were more prevalent in people with refractory epilepsy than in controls in a cross-sectional, retrospective analysis of electrocardiogram recordings.

Severe QTc prolongation was present in 5% of recordings from 185 patients with drug-refractory epilepsy, compared with none of those from 178 controls without epilepsy, and early repolarization pattern (ERP) was present in 34% vs. 13% of recordings from the patients and controls, respectively. After adjustment for epilepsy, gender, age, and heart rate, epilepsy remained associated with severe QTc prolongation (odds ratio, 9.9), and ERP (OR, 2.4), reported Dr. Robert J. Lamberts of Stichting Epilepsie Instellingen Nederland, Heemstede, the Netherlands (J. Neurol. Neurosurg. Psychiatry 2014 June 19 [doi:10.1136/jnnp-2014-307772]).

Recent data show that patients with epilepsy are at a two- to threefold increased risk of sudden cardiac arrest (SCA), and severe QTc prolongation and ERP are known markers for SCA risk in the general population. The current findings might explain why patients with epilepsy carry an increased risk of SCA, noted Dr. Lamberts and his colleagues.

"Routine ECG evaluation in people with epilepsy may be of importance in guiding clinicians in their choice of antiepilepsy drug therapy, for example, avoidance of QT-prolonging or depolarization-blocking drugs in people with ECG markers of increased SCA risk," they concluded.

The Dutch Epilepsy Foundation, Christelijke Vereniging voor de Verpleging van Lijders aan Epilepsie, and the Netherlands Organisation for Scientific Research funded the study. Dr. Lamberts had no disclosures. Coauthors disclosed ties with the Epilepsy Society, the Dr. Marvin Weil Epilepsy Research Fund, Eisai, GSK, UCB Pharma, the World Health Organization, the National Institutes of Health, NUTS Ohra Fund, Medtronic, the AC Thomson Foundation, the Swiss National Science Foundation, and the SICPA Foundation. 

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