[Interaction between heart and brain in sudden cardiac death]

[Acute diseases of the brain and heart : A reciprocal culprit-victim relationship]

The reciprocal culprit-victim relationship between the brain and the heart leads to dysfunction and damage to the other organ, especially in acute and severe diseases of one of both organs. In addition, both organ systems can be affected by identical systemic processes, e. g., arteriosclerotic changes. Cardiac embolic formation and pumping failure lead to focal cerebral ischemia or global hypoxia. Cerebral diseases leading to cardiac changes are acute cerebrovascular attacks such as cerebral infarction, intracerebral hemorrhage and subarachnoid hemorrhage, as well as epileptic seizures. The pathophysiological mechanisms of changes of the brain-heart axis include cerebrally induced autonomic dysregulation, neuroendocrine regulatory disorders, and systemic inflammatory processes. The effects on the heart are evident in up to 75% of patients with acute brain diseases leading to ECG changes, arrhythmias, increase in cardiac enzymes and myocardial damage even to sudden cardiac death. For this reason, cardiac monitoring should be provided in severe acute brain diseases.

Burden of Arrhythmias in Epilepsy Patients: A Nationwide Inpatient Analysis of 1.4 Million Hospitalizations in the United States

Arrhythmias have been one of the common complications in epilepsy patients and have also been the reason for death. However, limited data exist about the burden and outcomes of arrhythmias by subtypes in epilepsy. Our study aims at evaluating the burden and differences in outcomes of various subtypes of arrhythmias in epilepsy patient population. The Nationwide Inpatient Sample (NIS) database from 2014 was examined for epilepsy and arrhythmias related discharges using appropriate International Classification of Disease, Ninth Revision Clinical Modification (ICD-9-CM) codes. The frequency of arrhythmias, gender differences in arrhythmia by subtypes, in-hospital outcomes and mortality predictors was analyzed. A total of 1,424,320 weighted epilepsy patients was determined and included in this study. Around 23.9% (n =277,230) patients had cardiac arrhythmias. The most frequent arrhythmias in the descending frequency were: atrial fibrillation (AFib) 9.7%, other unspecified causes 7.3%, sudden cardiac arrest (SCA) 1.4%, bundle branch block (BBB) 1.2%, ventricular tachycardia (VT) 1%. Males were more predisposed to cardiac arrhythmias compared to females (OR [odds ratio]: 1.1, p <0.001). The prevalence of most subtypes arrhythmias was higher in males. Arrhythmias were present in nearly a quarter of patients with epilepsy. Life threatening arrhythmias were more common in male patients. The length of stay (LOS) and mortality were significantly higher in epilepsy patients with arrhythmia. It is imperative to develop early diagnosis and prompt therapeutic measures to reduce this burden and poor outcomes due to concomitant arrhythmias in epilepsy patients.