Abstract
Cardiac arrhythmias are a common complication of partial seizures, with ictal sinus tachycardia present in 16 out of 20 patients having undergone prolonged electrocardiographic (ECG) monitoring with implantable loop recorders. Ictal bradyarrhythmia and ictal asystole are more concerning but rare: a prevalence of 0.34–0.4% has been reported in large series. These situations have received a lot of attention recently because they have been postulated as one of the mechanisms underlying sudden unexpected death in epilepsy (SUDEP), although the supporting evidence remains fragmented. The few documented cases of SUDEP (or near-SUDEP) mainly showed apnoea and hypoventilation to be the terminal event, although there are some cases with a primary cardiac mechanism. We report the case of a patient suffering from drug-resistant focal epilepsy who developed ventricular fibrillation at the end of a convulsive seizure, requiring cardiopulmonary resuscitation (CPR).
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