Assistant Professor Chang Gung Memorial Hospital, Chiayi Branch Puzi City, Chiayi County, Taiwan (Republic of China)
Rationale: It has been suggested that seizure-induced cardiac dysfunction plays an important role in sudden unexpected death in epilepsy. However, it remains unclear whether seizures can induce secondary acute myocardial infarction (MI) or arrhythmia and subsequently increase the risk of sudden death in patients without a history of underlying heart disease. The aim of the study is to investigate the impact of epilepsy on secondary cardiac morbidities and sudden death in epilepsy patients. Methods: The present cohort study evaluated data obtained from a subset of adult patients listed in the Taiwan National Health Insurance Research Database with an International Classification of Diseases, Ninth Revision diagnosis code of epilepsy from January 1, 1997 to December 31, 2013; the date of epilepsy diagnosis or antiepilepsy drug prescription was defined as the index date. Patients diagnosed with cardiac disease prior to the index date were excluded, and the remaining patients were categorized into epilepsy and non-epilepsy groups. Frequency matching was performed to balance the covariates across groups for the comparison of outcomes. The development of MI and arrhythmia, and/or sudden death were the outcomes for evaluation. A Cox proportional hazards regression model and competing risk analysis were used to compare the risks of cardiac morbidities and sudden death between groups. Results: The final analysis included a total of 5,411 subjects diagnosed with epilepsy and 21,644 subjects without epilepsy. The epilepsy group had significantly higher risks of developing MI (HR: 1.71, 95% CI: 1.62–1.81) and arrhythmia (HR: 2.11, 95% CI: 1.97–2.25), and sudden death (HR: 1.83, 95% CI: 1.53–2.18) compared to the non-epilepsy group. Conclusions: The present results indicate that the risks of developing MI and arrhythmia, and sudden death were higher in epilepsy patients. These findings support the hypothesis that epilepsy may lead to secondary cardiac dysfunction and increases the risk of sudden death. Funding: Please list any funding that was received in support of this abstract.: This research received no external funding in support of this abstract.