Cardiac Conduction Delay for Sodium Channel Antagonist Antiseizure Medications: An Analysis of the Canadian Longitudinal Study on Aging.

IF 8.5 1区医学 Q1 CLINICAL NEUROLOGY Neurology Pub Date : 2025-02-25 Epub Date: 2025-02-03 DOI:10.1212/WNL.0000000000210302

Nathan A Shlobin, Jimmy Li, Josemir W Sander, Mark Robert Keezer, Roland D Thijs

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Abstract

Background and objectives: People with epilepsy are at risk of cardiac arrhythmias. Whether this association results from epilepsy, antiseizure medications (ASMs) such as sodium channel blockers (NABs), or other factors has not been systematically assessed. The aims of this study were to quantify the odds of cardiac conduction delays (CCDs) on electrocardiogram in older people with active epilepsy using vs not using NABs, to determine the prevalence of CCDs by NABs, and to examine the association of demographic and clinical factors with CCDs.

Methods: This was a cross-sectional study of the Canadian Longitudinal Study on Aging. We defined active epilepsy as self-reported epilepsy and taking ASM. Sodium channel blockers (NABs) were phenytoin, lamotrigine, carbamazepine, oxcarbazepine, or lacosamide. We compared CCDs between people with epilepsy using NABs and those not using NABs; determined the prevalence of CCDs by NAB type; and fitted a logistic regression model for each abnormal ECG outcome as a function of active epilepsy and NAB use while adjusting for demographics and clinical factors. Multiple imputations handled missing data (200 iterations).

Results: In total, 30,077 people, with mean age 63.0 (10.25) years and 50.9% female, were studied, including 141 people with active epilepsy who used NABs, 68 who did not use NABs, and 29,868 who did not have active epilepsy. Demographics between groups and relative to people without epilepsy were similar. People with active epilepsy taking NABs were more likely to have prolonged QRS (odds ratio [OR] = 2.85 [95% CI 1.09-7.43]) and any CCD (1.94 [1.03-3.63]) compared with those with active epilepsy without NAB. After adjusting for Framingham score and heart rate-lowering medications, NAB use was associated with prolonged QTc (OR = 1.52 [95% CI 1.06-2.18]) and any CCD (1.78 [1.16, 2.74]). The prevalence of any CCD was 36.1% [95% CI 24.2%-49.4%] for carbamazepine, 45.5% [31.7%-58.5%] for phenytoin, and 54.7% [28.9%-75.6%] lamotrigine. Epilepsy was not associated with any CCD.

Discussion: People with active epilepsy using NABs more commonly have CCDs. NAB use is associated with CCD, whereas active epilepsy is not.

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钠通道拮抗剂抗癫痫药物的心脏传导延迟：加拿大衰老纵向研究分析。

背景和目的：癫痫患者有发生心律失常的危险。这种关联是否与癫痫、抗癫痫药物（asm）如钠通道阻滞剂（nab）或其他因素有关，尚未得到系统评估。本研究的目的是量化使用与不使用nab的老年活动性癫痫患者心电图上心脏传导延迟（CCDs）的几率，确定nab的CCDs患病率，并检查人口统计学和临床因素与CCDs的关系。方法：这是加拿大老龄化纵向研究的横断面研究。我们将活动性癫痫定义为自我报告癫痫并服用ASM。钠通道阻滞剂（nab）有苯妥英、拉莫三嗪、卡马西平、奥卡西平或拉克沙胺。我们比较了使用nab和未使用nab的癫痫患者的ccd；按NAB类型确定CCDs患病率；在调整人口统计学和临床因素的同时，拟合了每个异常心电图结果作为活动性癫痫和NAB使用的函数的逻辑回归模型。多次输入处理丢失的数据（200次迭代）。结果：共纳入30,077例患者，平均年龄63.0（10.25）岁，女性50.9%，其中使用nab的活动性癫痫141例，未使用nab的68例，非活动性癫痫29,868例。两组之间以及相对于非癫痫患者的人口统计数据相似。与未服用NAB的活动性癫痫患者相比，服用NAB的活动性癫痫患者更有可能延长QRS（优势比[OR] = 2.85 [95% CI 1.09-7.43]）和任何CCD（1.94[1.03-3.63]）。在调整Framingham评分和降低心率药物后，NAB的使用与延长QTc （OR = 1.52 [95% CI 1.06-2.18]）和任何CCD（1.78[1.16, 2.74]）相关。卡马西平组CCD患病率为36.1% [95% CI 24.2% ~ 49.4%]，苯妥英组为45.5%[31.7% ~ 58.5%]，拉莫三嗪组为54.7%[28.9% ~ 75.6%]。癫痫与任何CCD无关。讨论：使用nab的活动性癫痫患者更常患有ccd。NAB的使用与CCD有关，而活动性癫痫则与之无关。

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来源期刊

Neurology 医学-临床神经学

CiteScore

12.20

自引率

4.00%

发文量

1973

审稿时长

2-3 weeks

期刊介绍： Neurology, the official journal of the American Academy of Neurology, aspires to be the premier peer-reviewed journal for clinical neurology research. Its mission is to publish exceptional peer-reviewed original research articles, editorials, and reviews to improve patient care, education, clinical research, and professionalism in neurology. As the leading clinical neurology journal worldwide, Neurology targets physicians specializing in nervous system diseases and conditions. It aims to advance the field by presenting new basic and clinical research that influences neurological practice. The journal is a leading source of cutting-edge, peer-reviewed information for the neurology community worldwide. Editorial content includes Research, Clinical/Scientific Notes, Views, Historical Neurology, NeuroImages, Humanities, Letters, and position papers from the American Academy of Neurology. The online version is considered the definitive version, encompassing all available content. Neurology is indexed in prestigious databases such as MEDLINE/PubMed, Embase, Scopus, Biological Abstracts®, PsycINFO®, Current Contents®, Web of Science®, CrossRef, and Google Scholar.