Ictal Asystole and Ictal Syncope
- 1 February 2015
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation: Arrhythmia and Electrophysiology
- Vol. 8 (1), 159-164
- https://doi.org/10.1161/circep.114.001667
Abstract
Background—: Ictal asystole is a rare, serious, and often treatable cause of syncope. There are currently limited data to guide management. Characterization of ictal syncope predictors may aid in the selection of high-risk patients for treatments such as pacemakers. Methods and Results—: We searched our epilepsy monitoring unit database from October 2003 to July 2013 for all patients with ictal asystole events. Clinical, electroencephalogram, and ECG data for each of their seizures were examined for their relationships with ictal syncope events. In 10 patients with ictal asystole, we observed 76 clinical seizures with 26 ictal asystole episodes, 15 of which led to syncope. No seizure with asystole duration ≤6 s led to syncope, whereas 94% (15/16) of seizures with asystole duration >6 s led to syncope ( P =0.02). During ictal asystole events, 4 patients had left temporal seizure onset, 4 patients had right temporal seizure onset, and 2 patients had both. Syncope was more common with left temporal (40%) than with right temporal seizures (10%; P =0.002). Treatment options included antiepileptic drug changes, epilepsy surgery, and pacemaker implantation. Eight patients received pacemakers. During follow-up of 72±95 months, all patients remained syncope free. Conclusions—: Ictal asystole >6 s is strongly associated with ictal syncope. Ictal syncope is more common in left than in right temporal seizures. A permanent pacemaker should be considered in patients with ictal syncope if they are not considered good candidates for epilepsy surgery.Keywords
This publication has 16 references indexed in Scilit:
- Sudden, Unexpected Death in EpilepsyThe New England Journal of Medicine, 2011
- Management and long-term outcome in patients presenting with ictal asystole or bradycardiaEpilepsia, 2011
- Guidelines for the diagnosis and management of syncope (version 2009): The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC)European Heart Journal, 2009
- Cardiac Effects of SeizuresEpilepsy Currents, 2009
- Differentiation of convulsive syncope from epilepsy with an implantable loop recorderInternational Journal of Medical Sciences, 2009
- Asystole Induced by Partial Seizures:. A Rare Cause of SyncopePacing and Clinical Electrophysiology, 2007
- Video-electrographic and clinical features in patients with ictal asystoleNeurology, 2007
- Clinical cues for detecting ictal asystoleClinical Autonomic Research, 2007
- Cardiac Asystole in Epilepsy: Clinical and Neurophysiologic FeaturesEpilepsia, 2003
- Cardiovascular effects of human insular cortex stimulationNeurology, 1992