Simultaneous electrocardiogram during routine electroencephalogram: arrhythmia rates through the eyes of the cardiologist

The Value of Concurrent Electrocardiography When Performing an Electroencephalograph

Introduction. The use of concurrent, single lead electrocardiograph (ECG) recording, when performing a routine electroencephalograph (EEG), has been standard practice for many years. Previous studies have reported on the usefulness of concurrent EEG in assessing syncope and the detection of newly identified cardiac dysrhythmia but have relied on specialist cardiologist interpretation of the ECG trace. This study expands the understanding of concurrent ECG and provides demographic information regarding the incidence, nature of ECG changes and diagnostic utility of ECG interpretation, during routine EEGs, as evaluated by neurologists. Methods. A single center, retrospective study of routine concurrent EEG and ECG recordings was performed. All routine EEGs, performed within a 12 month period were analysed. Demographic data, underlying comorbidities, reasons for referral and ECG changes were assessed. Results. ECG abnormalities were identified in 147 (13.5%) of concurrent ECG/EEG routine recordings. The presence of ECG abnormalities was significantly associated with the reason for referral, namely being assessed for the evaluation of seizure activity and with increasing patient age. Thirty-eight patients (3.5%) had newly identified ECG abnormalities, of which atrial fibrillation (AF) (12 patients) and sinus bradycardia (9 patients) were the most common. Five patients (0.5%) had a change in their management consequent to the identified ECG changes. Conclusions. These findings support the value of neurologists' interpretation and need for ongoing concurrent ECGs, during routine EEG recordings. The study raises concern about the requesting clinician's response to the identification of newly diagnosed cardiac dysrhythmias.

Routine Interictal EEG Recording Should be Performed Together with Simultaneous Two-Lead ECG Recording

We aimed to evaluate the contribution of simultaneous electrocardiography (ECG) recording during routine interictal electroencephalography (EEG) recording in patients with seizures or epilepsy and therefore to provide evidence-based data on this subject. Patients with interictal cardiac arrhythmia on routine EEG-ECG recordings were determined and evaluated based on cardiologic and neurologic findings. Out of 1,078 patients aged between 5 and 16 years (mean: 10.2 ± 3.2), 9 (0.08%) patients were found to have an arrhythmia. Six patients had both epilepsy and cardiac arrhythmia (premature ventricular contractions [PVCs] in 5; Wolff-Parkinson-White [WPW] in 1 patient) and the remaining three patients had nonepileptic paroxysmal events (NPEs) and arrhythmia (PVC in 2; WPW in 1). Three patients had other diseases (neurofibromatosis type 1, tuberous sclerosis, and congenital heart disease status postsurgery). Cardiac arrhythmia required radiofrequency ablation or antiarrhythmic drug treatment in two patients with epilepsy and also two patients with NPE; however, it improved with no specific treatment in the remaining five patients. NPE was not related to arrhythmia in one of three patients with NPE. Our study suggests that routine interictal EEG-ECG recording provides a valuable and feasible opportunity to reveal unnoticed or new-onset cardiac arrhythmias. Therefore, ECG should be recorded simultaneously during routine interictal EEG recordings. Cardiac arrhythmias detected by routine interictal EEG-ECG recordings would require arrhythmia treatment in nearly half of the patients.

Diagnostic value of electrocardiogram during routine electroencephalogram

INTRODUCTION

A single-lead electrocardiogram (EKG) is routinely recorded with electroencephalogram (EEG). This study investigates the frequency and types of EKG abnormalities during routine EEG.

METHODS

All routine EEGs (20-60 min) over one year were retrospectively analyzed. A blinded cardiologist interpreted EKG recordings. An epileptologist evaluated EEGs. Demographic data, underlying comorbidities, and indications for the EEG were extracted.

RESULTS

A total of 433 recordings for 365 patients were included. Mean (±SD) age was 46.8 (±21.3) years and 50.4% were females. EKG abnormalities were detected in 28.5% of patients; sinus tachycardia (11%), premature ventricular contractions (7.9%), atrial fibrillation (Afib) (6.3%), sinus bradycardia (2.2%) and premature atrial contractions (1.1%). Afib was more common in females than males (p = 0.020), confirmed in six out of seven patients and discovered in 17 patients. Age (OR: 1.67, 95%CI: 1.05-2.66, p = 0.031), prior diagnosis of epilepsy (OR: 2.25, 95% CI: 1.22 - 4.14, p = 0.009), history of seizure (OR: 1.97,  95%CI: 1.09-3.54, p = 0.024), abnormal EEG (OR: 2.14, 95%CI: 1.25 - 3.66, p = 0.005) and EEGs evaluating seizures/epilepsy (OR: 4.18, 95% CI: 1.32 - 13.21, p = 0.015) or syncope (OR: 3.21, 95% CI: 1.16 - 8.84, p = 0.024) were independently associated with abnormal EKG.

CONCLUSION

The frequency of EKG abnormalities captured during routine EEGs was high, with Afib being the most significant. Older age, history of epilepsy or seizure, abnormal EEGs, and EEGs evaluating seizures/epilepsy or syncope were significant predictors. These findings suggest neurologists to become more vigilant to EKG recorded during routine EEG as such findings might have diagnostic and therapeutic implications.