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Kaneko N, Watanabe M, Mori S, Turker I, Okamoto K, Urabe T, Ai T. Manifested U-Waves Prior to Seizure Attacks in a Patient Who Had Remote Subarachnoid Hemorrhage: A Case Report. Ann Noninvasive Electrocardiol 2024; 29:e70014. [PMID: 39297695 PMCID: PMC11411695 DOI: 10.1111/anec.70014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/23/2024] [Accepted: 08/29/2024] [Indexed: 09/25/2024] Open
Abstract
Sudden unexpected death in epilepsy (SUDEP) refers to unpredictable demise of a person following a seizure. Electroencephalograms can directly measure electrical activity in the brain; however, it cannot predict when seizures will occur. The use of electrocardiograms (ECGs) to monitor changes in brain electrical activity has gained attention, recently. In this case report, we retrospectively reviewed ECGs taken before and after seizure activity in a 75-year-old male who had a remote subarachnoid hemorrhage. Interestingly, U-waves appeared prior to his seizures and disappeared afterward, which suggests ECGs can be used to predict epilepsy in a certain population.
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Affiliation(s)
- Nao Kaneko
- Department of Laboratory MedicineJuntendo University Urayasu HospitalChibaJapan
| | - Masao Watanabe
- Department of NeurologyJuntendo University Urayasu HospitalChibaJapan
| | - Shusuke Mori
- Department of Emergency MedicineTokyo Women's Medical UniversityShinjukuJapan
| | - Isik Turker
- Division of Cardiology, Department of MedicineWashington University School of MedicineSt. LouisMissouriUSA
| | - Ken Okamoto
- Department of Emergency and Critical Care MedicineJuntendo University Urayasu HospitalChibaJapan
| | - Takao Urabe
- Department of NeurologyJuntendo University Urayasu HospitalChibaJapan
| | - Tomohiko Ai
- Department of Clinical Laboratory MedicineJuntendo University Urayasu HospitalChibaJapan
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Holkeri A, Eranti A, Haukilahti MA, Kerola T, Kenttä TV, Noponen K, Seppänen T, Rissanen H, Heliövaara M, Knekt P, Junttila MJ, Huikuri HV, Aro AL. Prevalence and Prognostic Significance of Negative U-waves in a 12-lead Electrocardiogram in the General Population. Am J Cardiol 2019; 123:267-273. [PMID: 30447954 DOI: 10.1016/j.amjcard.2018.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/01/2018] [Accepted: 10/05/2018] [Indexed: 11/18/2022]
Abstract
Negative U-waves are a relatively rare finding in an electrocardiogram (ECG), but are often associated with cardiac disease. The prognostic significance of negative U-waves in the general population is unknown. We evaluated 12-lead ECGs of 6,518 adults (45% male, mean age 50.9 ± 13.8 years) for the presence of U-waves, and followed the subjects for 24.5 ± 10.3 years. Primary end points were all-cause mortality, cardiac mortality, and sudden cardiac death; secondary end point was hospitalization due to cardiac causes. Negative U-waves (amplitude ≥0.05 mV) were present in 231 subjects (3.5%), minor negative (amplitude <0.05 mV) or discordant U-waves in 1,004 subjects (15.4%), normal positive U-waves in 3,950 (60.6%) subjects, and no U-waves were observed in 603 subjects (9.3%). In 730 subjects (11.2%), U-waves were unassessable. When adjusted for age and gender, negative U-waves were associated with all end points (p <0.01). In an analysis adjusted for multiple demographic and clinical factors, in men, negative U-waves were associated with increased risk of all-cause mortality (hazard ratio [HR] 1.60; 95% confidence interval [CI] 1.26 to 2.03; p <0.001), cardiac mortality (HR 1.74; 95% CI 1.26 to 2.39; p = 0.001), and cardiac hospitalization (HR 1.67; 95% CI 1.27 to 2.18; p <0.001), but not with sudden cardiac death, whereas women did not show a significant association to any of the end points (p >0.30). In conclusion, negative U-waves are associated with adverse events in the general population. In men, this association is independent of cardiovascular risk factors.
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Affiliation(s)
- Arttu Holkeri
- Division of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
| | - Antti Eranti
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - M Anette Haukilahti
- Research Unit of Internal Medicine, Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Tuomas Kerola
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - Tuomas V Kenttä
- Research Unit of Internal Medicine, Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Kai Noponen
- Center for Machine Vision and Signal Analysis, University of Oulu, Oulu, Finland
| | - Tapio Seppänen
- Center for Machine Vision and Signal Analysis, University of Oulu, Oulu, Finland
| | - Harri Rissanen
- National Institute for Health and Welfare, Helsinki, Finland
| | | | - Paul Knekt
- National Institute for Health and Welfare, Helsinki, Finland
| | - M Juhani Junttila
- Research Unit of Internal Medicine, Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Heikki V Huikuri
- Research Unit of Internal Medicine, Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Aapo L Aro
- Division of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
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Affiliation(s)
- Gerard B Hannibal
- Gerard B. Hannibal is Staff Nurse, Progressive Care Unit, The Louis Stokes Cleveland Department of Veterans Affairs Medical Center, 10701 East Blvd, Cleveland, OH 44106
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4
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Madias JE. Should we also be searching for a systolic “U wave” in the electrocardiogram? J Electrocardiol 2016; 49:628-9. [DOI: 10.1016/j.jelectrocard.2016.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Indexed: 10/22/2022]
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