SHM Converge Scientific Abstract ePoster Gallery-Ictal Asystole: A Rare Convergence of Arrhythmic Cardiac Syncope and Epilepsy

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This case report describes ictal bradyarrhythmia/asystole, a rare epilepsy-related cardiac phenomenon in which a seizure triggers marked bradycardia or asystole, leading to syncope. It highlights the diagnostic difficulty when seizure-related loss of consciousness overlaps with a cardiac cause of fainting.<br /><br />A 32-year-old woman with known focal epilepsy presented with recurrent drop attacks and loss of consciousness. Her episodes were not accompanied by tonic-clonic movements, prolonged confusion, or prodromal symptoms. Physical examination, vital signs, initial ECG, echocardiogram, brain imaging, and laboratory tests were all normal. Because the cause remained unclear, simultaneous EEG and ECG monitoring was performed in the epilepsy monitoring unit. During one episode, epileptiform activity was followed by a 10-second asystolic pause, confirming ictal asystole.<br /><br />Given the severity and persistence of her syncopal episodes despite medical therapy, electrophysiology was consulted, and she received a dual-chamber permanent pacemaker. After pacemaker placement, she had no recurrence of episodes, with long-term symptom control reported more than a decade later.<br /><br />The report emphasizes that ictal asystole should be considered in patients with unexplained transient loss of consciousness, especially when epilepsy is known or suspected. It also suggests that patients with persistent ictal pauses longer than 6 seconds may warrant cardiac electrophysiology evaluation for pacemaker candidacy. Pacemaker implantation can reduce morbidity and may provide a mortality benefit in selected patients, although many are not fully pacemaker-dependent and more research is needed.

Asset Subtitle

Matthew Czaja

Meta Tag

Author List Austin Rezigh, Matthew Czaja

Category Clinical Vignettes

Concept Ictal Bradyarrhythmia

Concept Asystole

Concept Seizure

Concept Cardiac Syncope

Concept Electroencephalography

Distinguished Non-Finalist

Presenter Organization University of Texas Health San Antonio

Presenting Author Matthew Czaja

Track Adult

Keywords

ictal asystole

ictal bradyarrhythmia

epilepsy

syncope

loss of consciousness

focal epilepsy

EEG ECG monitoring

asystolic pause

pacemaker implantation

cardiac electrophysiology

Ictal Bradyarrhythmia

Asystole

Seizure

Cardiac Syncope

Electroencephalography