Original Research
Sunday, November 12, 2023
12:45 PM–02:15 PM
Abstract
Introduction: Seizure medications used in the treatment of seizures and bipolar disorder can have cardiac risks including atherosclerotic cardiovascular disease and fatal arrhythmias. Seizure medications that block sodium channels can prolong QTC, QRS, and PR intervals on the electrocardiogram (ECG). Lamotrigine, a sodium channel blocker, is the first seizure medication with FDA warning with concerns of serious arrhythmias and/or death in people with underlying cardiac disorders. Because of this labeling change, the use of seizure medications with a similar mechanism of action should be used cautiously in the absence of additional information.
Research Question or Hypothesis: Does the use of seizure medications influence cardiac function in patients with and without comorbid cardiac conditions by causing changes in ECG patterns?
Study Design: Single-center, retrospective study June 2022 to February 2023.
Methods: Inclusion criteria: age =18 years and on seizure medication. Two cohorts studied, with or without cardiac comorbidities at baseline. Cardiac adverse events measured by changes in the QRS, QTc, PR interval, heart rate, blood pressure, and troponin level.
Results: Reviewed 2,600 patients. Seizure medications did not affect the QTc or QRS interval in patients with and without cardiac comorbidities. Increased QRS duration noted in patients with cardiac comorbidities irrespective of seizure medication use. Increase in PR interval seen in patients taking seizure medications without cardiac comorbidities (mean difference 8.033ms, p=0.0183). The significant increase in PR interval length in patients without cardiac comorbidities implies that seizure medication can affect ECG values.
Conclusion: Seizure medications may affect cardiac markers in patients with and without cardiac comorbidities. The clinical importance of these ECG changes in the real world with concomitant ECG interval prolonging medications has not been studied. Clinicians are cautioned to review these additive effects when prescribing seizure medications in patients with cardiac disease. Future studies are needed to better elucidate the clinical significance of additive medications which affect the ECG.
Presenting Author
Harminder Sikand Pharm.D., FCSHP, FASHP, FCCPScripps Mercy Hospital
Authors
Viktoriya Titova PharmD
Scripps