The Value of Concurrent Electrocardiography When Performing an Electroencephalograph

Abstract

Introduction. The use of concurrent, single lead electrocardiograph (ECG) recording, when performing a routine electroencephalograph (EEG), has been standard practice for many years. Previous studies have reported on the usefulness of concurrent EEG in assessing syncope and the detection of newly identified cardiac dysrhythmia but have relied on specialist cardiologist interpretation of the ECG trace. This study expands the understanding of concurrent ECG and provides demographic information regarding the incidence, nature of ECG changes and diagnostic utility of ECG interpretation, during routine EEGs, as evaluated by neurologists. Methods. A single center, retrospective study of routine concurrent EEG and ECG recordings was performed. All routine EEGs, performed within a 12 month period were analysed. Demographic data, underlying comorbidities, reasons for referral and ECG changes were assessed. Results. ECG abnormalities were identified in 147 (13.5%) of concurrent ECG/EEG routine recordings. The presence of ECG abnormalities was significantly associated with the reason for referral, namely being assessed for the evaluation of seizure activity and with increasing patient age. Thirty-eight patients (3.5%) had newly identified ECG abnormalities, of which atrial fibrillation (AF) (12 patients) and sinus bradycardia (9 patients) were the most common. Five patients (0.5%) had a change in their management consequent to the identified ECG changes. Conclusions. These findings support the value of neurologists’ interpretation and need for ongoing concurrent ECGs, during routine EEG recordings. The study raises concern about the requesting clinician's response to the identification of newly diagnosed cardiac dysrhythmias.