Cardiac asystole provoked by epileptic seizures is a rare but important complication in epilepsy and is supposed to be relevant to the pathogenesis of sudden unexplained death in epilepsy (SUDEP). We sought to determine the frequency of this complication in a population of patients with medically intractable epilepsy and to analyze the correlation between EEG, electrocardiogram (ECG), and clinical features obtained from long-term video-EEG monitoring. Cardiac asystole (EACA) in patients without structural heart disease is uncommonly encountered. Two patients who developed prolonged asystolic arrest associated with exercise are described; both demonstrated a positive head-up tilt table response, absence of underlying heart disease, and a history of vagotonia.
A review of this condition in the literature suggests the occurrence of this syndrome of EACA in young men with atheletic inclination who developed syncope usually after a strenuous exercise at a high heart rate. Although the described patients usually responded by avoiding maximal exercise and the use of ß-blockade, vagolytic agent, and permanent pacing, EACA may be the link for some cases of exercise-related asystolic deaths.
In medicine, asystole is a state of no cardiac electrical activity, hence no contractions of the myocardium and no cardiac output or blood flow. Asystole is one of the conditions required for a medical practitioner to certify death. In asystole, the heart will not respond to defibrillation because it is already depolarized, however some emergency physicians advocate a trial of defibrillation in case the rhythm is actually fine ventricular fibrillation, although little evidence exists to support the practice. Asystole is usually a confirmation of death as opposed to a heart rhythm to be treated, although a small minority of patients are successfully resuscitated, if the underlying cause is identified and treated immediately.
When the incidence of coronary artery disease in the population of a country is relatively low, asystole is relatively more common as a manifestation of cardiopulmonary arrests. This is because cardiac ischemia more frequently results in VF. Asystole is most likely to be found in cardiopulmonary arrests occurring in children; this is usually secondary to another noncardiac event (ie, respiratory arrest due to sudden infant death syndrome, infection, choking, drowning, or poisoning). Frequency of asystole, as a percentage of all cardiopulmonary arrests, is higher in women than in men; however, the frequency of cardiac arrest in general is proportional to the underlying incidence of heart disease, which is more common in males until around 75 years of age.
A 44-year-old right-handed woman with a family history of epilepsy had had staring spells and episodes of loss of consciousness since early childhood. After two recent convulsions, therapy with valproic acid and carbamazepine was started. Despite anticonvulsant treatment, she continued to have frequent 1-minute staring episodes. Results of physical and neurologic examinations, computed tomography of the head, and electrocardiography were normal. During monitoring, epileptiform discharge over the left hemisphere was associated with a staring spell and random leg movements, followed by 26 seconds of asystole.
Cardiac asystole, which may have been caused by Bezold-Jarisch reflex as a result of hypovolemia and compression of the inferior vena cava by a huge pyometra. A 61-year-old woman with a huge pyometra with occasional supine hypotension, tachycardia, and oliguria was scheduled for removal of the tumor. The systolic blood pressure decreased from 80 mmHg to 55 mmHg with simultaneous development of bradycardia 5 minutes after incision of the abdominal wall. Atropine was given but cardiac asystole occurred. Intravenous epinephrine restored systemic blood pressure and heart beats. There was no postoperative cardiorespiratory complication.
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