Apical left ventricular lipoma presenting as syncope

Abstract

1 I-second pause (Fig. 1). After the sinus pause, a marked decrease in waveform amplitude was noted bilaterally on the EEG followed by low-amplitude generalized fast activity, which corresponded clinically to tonic-clonic seizure activity. Thirty seconds after the onset of the seizure and the return of the heart rate to baseline, there was cessation of seizure activity clinically and on EEG. A permanent VVI pacemaker was implanted the following day without complications. Telemetry monitoring after insertion of a pacemaker revealed no further episodes of bradycardia. The patient has had no further episodes of syncope or seizure activity during 14 months of follow-up. Although loss of consciousness as a result of inadequate cardiac output is a common symptom associated with cardiac arrhythmias, frank seizure activity is a rare occurrence.z-s This is the first report in which a seizure precipitated by a period of asystole was documented by standard, simultaneous EEG and ECG recordings. As illustrated by this case, a marked reduction in EEG amplitude after the period of asystole is characteristic of cerebral ischemia and is the likely precipitant of the seizure. Without the use of simultaneous EEG and ECG monitoring, a correct diagnosis could not have been made. Thus all adults with a newonset seizure disorder, in whom routine EEG is nondiagnostic, should have a careful cardiac and neurologic evaluation, This is particularly relevant in elderly persons who may have unsuspected conduction system disease. The use of simultaneous EEG and ECG recordings or ambulatory EEG and ECG monitoring may provide useful diagnostic information and allow the physician to institute appropriate therapy.