Specialty Focused Recordings: Seizures and Epilepsy-Ictal Asystole

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Video Summary

Nurses Phyllis Dubendorf and Colleen Peachy discussed ictal asystole, a rare seizure-associated cardiac event defined as several seconds without ventricular activity. It occurs in roughly 0.3–0.4% of epilepsy patients and is often linked to temporal-lobe seizures. Seizure activity, autonomic pathways, genetic factors, and some antiseizure medications may contribute. Most episodes resolve spontaneously, but they can cause injury or require resuscitation; their relationship to SUDEP remains uncertain.<br /><br />The speakers presented three Epilepsy Monitoring Unit cases. One patient underwent cardioneuroablation and later had no further seizure-associated rhythm disturbances. Two others received permanent pacemakers after events thought to have a stronger cardiac component. These cases underscored the need to distinguish seizure-driven asystole from primary cardiac dysfunction through neurologic and cardiac evaluation.<br /><br />The team developed individualized safety plans, including escalation to higher-acuity care for prolonged pauses, bedside defibrillator pads, access to atropine, and consultation with cardiology and electrophysiology. The presenters emphasized that treatment may include seizure control or surgery, cardioneuroablation, or pacemaker placement, depending on the cause and clinical circumstances.

Keywords

ictal asystole

epilepsy

temporal-lobe seizures

cardioneuroablation

pacemaker

seizure monitoring unit

cardiac evaluation