Risk of ECG abnormalities and arrhythmias in people with post-traumatic epilepsy.

BACKGROUND: People with traumatic brain injury (TBI), particularly those who develop post-traumatic epilepsy (PTE, unprovoked seizure >1-week post-TBI), are at a high risk of mortality. Lethal arrhythmias represent one potential cause of mortality. OBJECTIVE: The goal of this study is to investigate the risk of electrocardiographic (ECG) abnormalities and arrhythmias in people with TBI that develop PTE vs. those that do not. METHODS: Analysis was performed using the TriNetX platform. Selection criteria included one lifetime TBI, 18-55 years old at the time of TBI, and survived > 1-week post-TBI. People with pre-TBI history of seizures, epilepsy, arrhythmias, or heart disease were excluded. We compared the time-dependent risk of arrhythmias and ECG abnormalities > 1-week post-TBI in PTE (seizure or epilepsy diagnosis >1-week post-TBI) versus propensity-score-matched non-PTE cohorts (N = 11,092/group). Follow-up was 1-week to 10-years post-TBI. RESULTS: PTE is associated with a 3-fold increased prevalence of the composite outcome (all ECG abnormalities and arrhythmias) and 5-fold increased prevalence of ventricular arrhythmias. There is decreased freedom from (log-rank p < 0.001), and increased time-dependent risk of the composite outcome (hazard-ratio: 2.26 [2.11-2.42]), and each type of ECG abnormality and arrhythmia. Sub-analysis stratifying for type of TBI, presence/absence of anti-seizure medications, post-traumatic (≤48-hours post-TBI) seizures, and post-traumatic arrhythmias, each demonstrate that people with PTE are at an increased risk of ECG abnormalities and arrhythmias. CONCLUSION: Results indicate the high risk of ECG abnormalities and arrhythmias in PTE. While PTE is principally a neurological disorder, it is important to take a multi-system approach that includes cardiac monitoring.