Association between anti-seizure medications and cardiac arrhythmias in patients undergoing ambulatory electroencephalographic and electrocardiographic monitoring

Abstract

Background Anti-seizure medications (ASMs) are commonly prescribed in epilepsy. However some have been associated with adverse cardiac outcomes including cardiac arrhythmias.

Methods We conducted an observational study evaluating patients aged ≥16 years undergoing ambulatory video – electroencephalographic (EEG) – electrocardiographic (ECG) monitoring (AVEEM) between 2020 and 2023 in Australia. Data collected included baseline demographics, type, number and dose of ASMs and cardiac arrhythmias during monitoring. ASMs were not withdrawn while monitored. Average QT interval was calculated and corrected for heart rate (QTc). Logistic regression was used to evaluate association between demographic variables, ASMs and cardiac arrhythmias.

Results 3695 patients underwent AVEEM (median age 40 years [interquartile range 26–57], female 64 %). Median AVEEM duration was 6.8 days. 51 % of patients were taking ≥1 ASMs. About 28 % (1029/3695) patients had a cardiac arrhythmia; the most frequent was non-sustained SVT (19 %; 695/3695). On multivariable analysis, carbamazepine (OR 0.72, 95 %CI 0.53–0.98, p = 0.03), lamotrigine (OR 0.57, 95 %CI 0.44–0.73, p<0.001) and lacosamide (OR 0.63, 95 %CI 0.43–0.92, p = 0.02) were associated with fewer cardiac arrhythmias. Their association with cardiac arrhythmias was not dose-dependent. No commonly-prescribed ASMs were associated with increased risk of cardiac arrhythmias. There was no significant association between use of ASMs and dynamic QTc interval change.

Conclusions Certain ASMs, namely carbamazepine, lamotrigine and lacosamide, were associated with fewer cardiac arrhythmias and this association was not dose-dependent. No other ASM was associated with cardiac arrhythmias. Further large clinical prospective studies are needed to confirm these findings and to clarify the mechanism for any potential antiarrhythmic properties of ASMs.