Electrocardiographic abnormalities in epilepsy: analysis of cardiac conduction patterns and SUDEP Risk

Background: Electrocardiographic (ECG) abnormalities in epilepsy patients may contribute to sudden unexpected death in epilepsy (SUDEP). This systematic review and meta-analysis evaluated the prevalence of ECG abnormalities in epilepsy patients, their age-specific patterns, and association with mortality risk. Methods: Following PRISMA guidelines, we systematically searched major databases through September 2024 for studies reporting ECG findings in epilepsy patients. We analyzed 11 studies (2,775 epilepsy patients, 2,751 non-epileptic subjects) using random-effects models for prevalence rates, mean differences, and conducted age-stratified and mortality analyses. Results: QRS axis deviation emerged as the most robust epilepsy-associated cardiac abnormality, occurring seven-fold more frequently in epilepsy patients compared to controls (23.1% vs 3.2%, p = 0.033). T wave abnormalities showed significantly higher prevalence in epilepsy patients versus controls (31.2% vs 5.0%, p = 0.039). ST segment changes demonstrated a 3.6-fold increased risk in epilepsy patients (RR: 3.55, 95% CI: 1.36–9.22). Age-stratified analysis revealed prolonged QTc was significantly more common in adults compared to pediatric patients (13.5% vs 2.4%, p = 0.04). Mortality analysis showed no significant differences in basic ECG parameters between deceased and surviving epilepsy patients. Basic cardiac parameters including heart rate, PR interval, and QRS duration remained comparable between epilepsy and control groups. Conclusions: Epilepsy patients exhibit distinct cardiac electrical abnormalities, particularly conduction axis and repolarization changes. However, these retrospective findings with substantial heterogeneity represent potential indicators of electrophysiological instability rather than validated SUDEP biomarkers. Rigorous prospective validation is essential before clinical implementation.