Cardiac Conduction Delay for Sodium Channel Antagonist Antiseizure Medications: An Analysis of the Canadian Longitudinal Study on Aging (CLSA)
Abstract number :
1.417
Submission category :
7. Anti-seizure Medications / 7C. Cohort Studies
Year :
2024
Submission ID :
828
Source :
www.aesnet.org
Presentation date :
12/7/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Jimmy Li, MD – Centre hospitalier univesitaire de Sherbrooke (CHUS)
Nathan Shlobin, MD – Northwestern University Feinberg School of Medicine
Josemir W Sander, FRCP FMedSci – Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1N 3BG & Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, United Kingdom
Mark Keezer, MD PhD – Centre hospitalier univesitaire de Montréal (CHUM)
Roland Thijs, MD PhD – Stichting Epilepsie Instellingen Nederland, Heemstede
Rationale: People with epilepsy are at risk of cardiac arrhythmias. This association may result from epilepsy, antiseizure medications such as sodium channel blockers (NAB), or other factors. We investigated the odds of cardiac conduction delays (CCDs) on electrocardiogram (ECG) in older people with active epilepsy using NAB versus those not using NAB, determined the prevalence of CCD by NAB, and examined the association of demographic and clinical factors with CCDs.
Methods: We focused on 209 people with active epilepsy and 29,868 without, aged 45-85 years at baseline, from the Canadian Longitudinal Study on Aging. We defined active epilepsy as self-reported epilepsy and taking antiseizure medication. NABs were phenytoin, lamotrigine, carbamazepine, oxcarbazepine, or lacosamide. We examined baseline ECGs for CCDs, including prolonged PQ ( >200 ms), QRS ( >100 ms), and QTc ( >430 ms for males and >450 ms for females). Logistic regression models estimated the association between CCD and age, sex, active epilepsy, and NAB, with or without Framingham score or heart rate-lowering medications (HRLRX). Missing data were handled using multiple imputations (200 iterations).
Results: In total, 141 people with active epilepsy used NAB, and 68 did not, with similar demographics between groups and relative to people without epilepsy (Table 1). Our univariate analyses showed that people with active epilepsy taking NAB 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]) than people with active epilepsy not taking NAB. These univariate analyses did not detect any significant difference in the likelihood of having prolonged PQ or QTC intervals between the two groups. After adjusting for Framingham score and HRLRX (Table 2), NAB was associated with prolonged QTc (OR = 1.52 [95% CI: 1.06, 2.18]) and any CCD (1.78 [1.16, 2.74]). Epilepsy was not associated with CCD. The probability 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%] for lamotrigine. Other NAB such as lacosamide and oxcarbazepine were taken too infrequently by participants to generate meaningful estimates for probabilities of CCD.
Conclusions: People with active epilepsy using NAB more commonly have CCD on ECG. NAB use is associated with CCD, while active epilepsy is not. A baseline ECG is warranted for selected individuals with epilepsy.
Funding: None.
Anti-seizure Medications