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World J Clin Cases. Oct 16, 2015; 3(10): 872-875
Published online Oct 16, 2015. doi: 10.12998/wjcc.v3.i10.872
Arrhythmogenic epilepsy and pacing need: A matter of controversy
Alper Kepez, Okan Erdogan
Alper Kepez, Okan Erdogan, Marmara University Training and Research Hospital, Cardiology Clinic, 34890 Istanbul, Turkey
Author contributions: Kepez A performed the majority of writing and data accusation; Erdogan O designed the outline and coordinated the writing of the paper.
Conflict-of-interest statement: There is no conflict of interest associated with any of the authors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Alper Kepez, Associate Professor, Marmara University Training and Research Hospital, Cardiology Clinic, Pendik, 34890 Istanbul, Turkey. alperkepez@yahoo.com
Telephone: +90-532-2201899
Received: May 24, 2015
Peer-review started: May 26, 2015
First decision: July 10, 2015
Revised: July 21, 2015
Accepted: August 20, 2015
Article in press: August 21, 2015
Published online: October 16, 2015
Processing time: 145 Days and 17.4 Hours
Abstract

There is increasing awareness among the cardiology community regarding ictal bradyarrhythmias as a cause of loss of consciousness. A high degree of suspicion is necessary when diagnosing ictal bradyarrhythmias, and delay in diagnosing this condition may lead to morbidity associated with falls and trauma. Ictal bradyarrhythmias have also been suggested to be associated with sudden unexplained death in epilepsy, although evidence related to this association is limited. There is no guideline-directed therapy for symptomatic ictal bradyarrhythmias due to a lack of randomized, controlled trials. Cardiac pacemaker therapy is commonly used for these patients; however, currently, there is no universal agreement on the pacing indications for these patients. In this review, we focus on the pathophysiology and clinical presentation of ictal bradyarrhythmias and then discuss the pacing need based on the available literature data.

Keywords: Arrhythmogenic epilepsy; Syncope; Ictal bradyarrhythmia; Pacemaker; Anticonvulsive therapy

Core tip: There is increasing awareness among the cardiology community regarding ictal bradyarrhythmias as a cause of loss of consciousness. Pacing is commonly used therapy for symptomatic ictal bradyarrhythmias. However, currently, there is no universal agreement on the pacing indications for these patients due to lack of randomized, controlled trials. In this review we will first focus on pathophysiology and clinical presentation of ictal bradyarrhythmias and then try to discuss the pacing need based on the available literature data.