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Abstract Details

T-wave Heterogeneity is Superior to QTc in 12-Lead ECG in Detection of Cardiac Electrical Instability at EMU Admission
Epilepsy/Clinical Neurophysiology (EEG)
S35 - Epilepsy/Clinical Neurophysiology (EEG): Clinical Epilepsy (1:36 PM-1:48 PM)
004
  • The Epileptic Heart, detectable by elevations in RWH and TWH, results from chronic epilepsy-induced cardiac injury leading to electrical and mechanical dysfunction, and is associated with elevated risk for sudden cardiac death (SCD).  QT-interval prolongation is also associated with increased all-cause mortality in epilepsy and the general population.
  • We investigated whether R-wave and T-wave heterogeneity (RWH, TWH) in 12-lead ECGs at epilepsy monitoring unit (EMU) admission is superior to QT-interval prolongation in detecting cardiac electrical instability in epilepsy patients.
  • In all 132 patients with EMU admission day 12-lead ECGs between 2017 and 2021 at our institution, we determined corrected QT (QTc) intervals from clinical records and RWH and TWH levels by second central moment analysis, in patients with generalized tonic-clonic seizures (GTCS), focal seizures (FS), and nonepileptic seizures (NES) only.
  • Patients with GTCS (n=66) and FS (n=36) had significantly elevated RWH of 168±9.9 µV (p< 0.03) and 165±12 µV (p< 0.04) respectively, compared to those with NES (n=30) (125±10.5 µV), as previously reported.  TWH was also abnormally elevated in patients with GTCS (83±5.9 µV, p< 0.05), and FS (79±4.8 µV, p<0.02), compared to NES (61±5.0 µV).  Both RWH and TWH were within the normal range in patients with NES only.  By comparison, mean QTc was in the normal range for patients with epilepsy and those with NES, at 422±3 ms and 436±5 ms, respectively.

  • This is the first study to demonstrate the superior capacity of RWH and TWH to detect cardiac electrical instability in epilepsy patients compared to QTc in 12-lead ECGs.  These observations suggest that RWH and TWH may be more sensitive markers of potential susceptibility to SCD or sudden unexpected death in epilepsy (SUDEP). ECGs are clinically readily available and these markers could provide a means to monitor sudden death risk longitudinally.
Authors/Disclosures
Trudy Pang, MD (Beth Israel Deaconess Medical Center)
PRESENTER 		Dr. Pang has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Stratus an Alliance Company.
Wan Yee Kong, MBBS (DMC) Dr. Kong has nothing to disclose.
Anthony P. Tran, MD (Beth Israel Deaconess Medical Center) Dr. Tran has nothing to disclose.
Calvin Yu, MD (Mount Sinai South Nassau) Dr. Yu has nothing to disclose.
Yvo A. Rodriguez-Linares, MD (UTHealth McGovern Medical School Neurology Department) Dr. Rodriguez-Linares has nothing to disclose.
No disclosure on file
Steven C. Schachter, MD, FAAN Dr. Schachter has received personal compensation in the range of $0-$499 for serving as a Consultant for Supernus Pharmaceuticals. Dr. Schachter has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Schachter has received intellectual property interests from a discovery or technology relating to health care. Dr. Schachter has received publishing royalties from a publication relating to health care. Dr. Schachter has received publishing royalties from a publication relating to health care.
No disclosure on file