Does cardiac conduction pathology contribute to sudden unexpected death inepilepsy?

Heart weights have been reported to be increased in those dying suddenly an d unexpectedly from epilepsy (SUDEP) and it has been suggested that cardiac pathology including cardiac conduction pathology and coronary artery ather oma may contribute to SUDEP. The purpose of this study was to perform a det ailed controlled study of the microscopic pathology of the cardiac conducti on system in SUDEP cases, in addition to assessing coronary artery atheroma and other cardiac pathology. The hearts of ten SUDEPs and ten control subj ects (no history of epilepsy and a cause of death not primarily cardiac) we re examined macroscopically and microscopically by two pathologists blinded to the patient group. Morphological abnormalities of the cardiac conductio n system that could have possibly contributed to death were not increased i n the SUDEP group (four cases showed such changes in the SUDEP group vs, si x in the control). There was no significant difference between the maximal percentage coronary artery stenoses between the two groups and no increased prevalence of other cardiac pathology in the SUDEP group. However, since s ubtle abnormalities of the conduction system were identified in some of the epileptic deaths, it is still feasible that these may contribute to death by causing cardiac arrhythmia, when associated with apnoea, bradycardia or other cardiac arrhythmia related to an epileptic seizure. (C) 2000 Elsevier Science B.V. All rights reserved.