269 Ventricular Fibrillation after a Seizure – a Case of Near SUDEP

Abstract

Sudden unexplained death in epilepsy (SUDEP) is a serious complication of seizure disorders. Malignant ventricular arrythmias after a seizure are rarely reported in the literature and only in patients with diagnosed epilepsy. This is the first case to report ventricular fibrillation after a first seizure. A 24-year-old critical care nurse with no significant past medical history was on duty when she was seen to collapse with a generalized tonic-clonic seizure. This lasted about 90 seconds. Post convulsions, she was noted to be cyanotic with agonal breathing. Advanced life support with CPR was commenced and initial rhythm check revealed ventricular fibrillation. A single 200 joule DC cardioversion restored her to sinus rhythm. Over the next 15 minutes she had 2 further seizures requiring sedation and intubation. Rhythm on the telemetry during these next two seizures showed sinus tachycardia. Laboratory and urine testing was normal. ECG revealed sinus tachycardia with a QTC of 420ms. Subsequent MRI brain, electroencephalogram and echocardiogram normal. Cardiac CT revealed normal coronary arteries and cardiac MRI scan showed no evidence of scar. Levetiracetam 1g BD was commenced and she was extubated within 24 hours. A subcutaneous implanted cardioverter defibrillator was inserted and referral made to cardiac genetics clinic. In up to 60% of patients with VF or sudden cardiac death, no cause can be found. Seizure or epilepsy could potentially account for some of these cases.