Incidence and Prevalence of Cardiac Arrhythmias With Epilepsy Drugs
William Crumb1, Clarence Wade2, Sean Stern2, Esther Kim3, Sunny Guin3, Nadia Tabatabaeepour3, Sally Omidvar3, Louis Ferrari2
1Nova Research Laboratories, 2SK Life Science, Inc., 3Truveta, Inc
Objective:
To characterize the prevalence and incidence of arrythmias among patients in a large US database.
Background:
Recently, the FDA issued a Drug Safety Communication for the antiepileptic drug lamotrigine warning of possible QRS prolongation and proarrhythmia.
Design/Methods:

Using data from Truveta, an EMR-based platform with patient records from 31+ US health systems as of December 2023, we examined the prevalence and incidence in 2023 of ventricular arrhythmias and cardiac arrhythmias. Patient groups included epilepsy patients receiving any one of 27 ASMs, epilepsy patients not receiving ASMs, and non-epilepsy patients with a record of any other condition. We also examined the prevalence and incidence of arrhythmias in each monotherapy ASM group. Of the 27 ASMs, 13 had enough relevant data to be included in the monotherapy groups.

Results:

Of the three patient groups (total N=32,063,470), the prevalence of all-type cardiac arrhythmias was 23.2% among treated epilepsy patients (n=264,935), 17.6% among untreated epilepsy patients (n=96,028), and 9.8% among non-epilepsy patients (n=31,702,507). The prevalence of ventricular arrhythmias was 2.9%, 1.8%, and 1.3% among treated epilepsy patients, untreated epilepsy patients, and non-epilepsy patients, respectively. The incidence of new arrhythmias was 1.8%, 1.2%, and 0.7% among treated epilepsy patients, untreated epilepsy patients, and non-epilepsy patients, respectively. There was variability in the prevalence and incidence of arrhythmias, independent of the patient group size, when various ASMs were taken as monotherapy.

Conclusions:
Patients with epilepsy had a higher burden of arrhythmias when compared to non-epileptic patients and epilepsy patients taking ASMs had a higher burden of arrhythmias than those not taking ASMs. Overall, the incidence of new arrhythmias in epileptic patients was low (less than 2%), independent of taking ASMs. For ASMs taken as monotherapy, there was a wide variability of arrhythmia burden. This suggests that some ASMs may be more likely to cause arrythmias than others.
10.1212/WNL.0000000000208548
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