Diagnostic value of electrocardiogram during routine electroencephalogram

• Published in: Seizure (London, England) England), 2021-07, Vol.89, p.19-23
• Main Authors: Yassin, Ahmed, El-Salem, Khalid, Khassawneh, Basheer Y., Al-Mistarehi, Abdel-Hameed, Jarrah, Mohamad, Zein Alaabdin, Anas M., Abumurad, Sumayyah K., Qasaimeh, Mohammad G., Bashayreh, Salma Y., Kofahi, Raid M., Alhayk, Kefah A., Alshorafat, Duha, Al Qawasmeh, Majdi
• Format: Article
• Language: English
• Subjects: Arrhythmias; Atrial fibrillation; EEG; EKG; Electrocardiogram; Electroencephalogram
• ISSN: 1059-1311; 1532-2688
• DOI: 10.1016/j.seizure.2021.04.016

•This study described the cardiac arrhythmias captured on the electrocardiogram (EKG) channel recorded simultaneously with short electroencephalograms (EEGs).•EKG abnormalities were relatively common, with almost one-third of recordings showing one or more abnormalities.•Sinus tachycardia and premature ventricular contractions were the most commonly observed findings, followed by atrial fibrillation.•The presence of abnormal EKG was significantly associated with older age, prior diagnosis of epilepsy, history of seizure, abnormal EEG, and EEGs requested to evaluate for seizures/epilepsy or syncope.•This study invites neurologists to be more attentive to EKG findings during routine EEG. : A single-lead electrocardiogram (EKG) is routinely recorded with electroencephalogram (EEG). This study investigates the frequency and types of EKG abnormalities during routine EEG. : 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. : 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. : 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.