Abnormal repolarization: A common electrocardiographic finding in patients with epilepsy

Katsuhide Hayashi, Ritsuko Kohno, Naoki Akamatsu, David G. Benditt, Haruhiko Abe

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BACKGROUND: Recently, certain forms of early repolarization (ER) on electrocardiograms (ECGs) have been considered a possible marker of increased sudden cardiac death risk. The frequency, characteristics, and clinical follow-up with which these forms of ER are present in epilepsy patients, and whether or not abnormal ER contributes to sudden unexplained death in epilepsy patients (SUDEP) is unknown.

METHODS AND RESULTS: The amplitude of J peak and ST-segment morphology after ER on 12-lead ECGs were assessed in 354 epilepsy patients (age, 33 ± 16 years; 54% men) and 140 age- and sex-matched control subjects (age, 31 ± 12 years; 50% men). Abnormal ER prevalence (J-wave amplitude ≥0.1 mV) was greater in epilepsy patients (19.8%) compared with controls (8.6%; P = 0.002) in inferior ECG leads but not in lateral leads ( P = 0.40). ER with a horizontal or descending ST segment was also more prevalent in epilepsy patients ( P < 0.001). After introducing antiepileptic drugs in 36 epilepsy patients, there were no significant ER changes. Similarly, in 64 epilepsy patients with seizure suppression, ER comparison before and after seizure control revealed no significant changes. Male gender was the only significant predictor of abnormal ER in epilepsy patients ( P = 0.03). During a median follow-up of 7 years, SUDEP occurred in two patients, one with abnormal ER.

CONCLUSIONS: Abnormal ER may be more prevalent in epilepsy patients than in controls and is not altered by antiepileptic drugs or achievement of epilepsy suppression. The relation of abnormal ER to SUDEP remains in need of further study.

Original languageEnglish (US)
Pages (from-to)109-115
Number of pages7
JournalJournal of cardiovascular electrophysiology
Issue number1
StatePublished - Jan 2019

Bibliographical note

Funding Information:
Haruhiko Abe, MD, PhD, Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan, 1‐1, Iseigaoka Yahatanishiku, Kitakyushu 807‐8555, Japan. Email: haru-abe@med.uoeh-u.ac.jp This study was supported partially by grant‐in‐ aid 25461081 and 17K09539 from the Ministry of Education, Culture, Sports, Science, and Technology in Japan (Dr Abe), and by a grant from Kitakyushu Foundation for the Advancement of Industry Science and Technology (FAIS) in 2015‐2016 (Dr Abe). Dr Benditt is supported in part by a grant from the Dr Earl E. Bakken family in support of heart and brain research.

Publisher Copyright:
© 2018 Wiley Periodicals, Inc.


  • autonomic nervous system
  • early repolarization
  • electrocardiogram
  • epilepsy
  • sudden death

PubMed: MeSH publication types

  • Research Support, Non-U.S. Gov't
  • Journal Article


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