ABSTRACT
BACKGROUND: The relationship between seizure activity and arrhythmias is not well established. Sinus tachycardia is commonly seen post seizure. Bradyarrythmias leading to seizure activity is rarely reported in the literature thus far. CASE PRESENTATION: A 62-year-old lady presented with nocturnal seizures and was subsequently started on oral anti-convulsant with no relief of her symptoms. Further investigations led to outpatient ambulatory ECGs which showed marked sinus bradycardia prior to seizure activity and post seizure atrial fibrillation with fast ventricular rate. The patient was commenced on oral anticoagulant and beta blocker for ventricular rate control in view of atrial fibrillation. A backup dual chamber permanent pacemaker was implanted to treat the bradycardia. The patient became seizure free since the implantation of permanent pacemaker. CONCLUSION: This case stresses the importance of investigating and treating cardiac arrhythmias underlying seizure activity.
Subject(s)
Bradycardia/complications , Seizures/etiology , Atrial Fibrillation/complications , Atrial Fibrillation/diagnosis , Bradycardia/diagnosis , Electrocardiography , Female , Humans , Middle Aged , Pacemaker, ArtificialABSTRACT
BACKGROUND: Dramatic artifacts of pseudo flutter have been reported in the past secondary to various factors including tremor (Handwerker and Raptopoulos in N Engl J Med 356:503, 2007) and dialysis machines (Kostis et al. in J Electrocardiol 40(4):316-318, 2007). METHODS: We present this unusual case where the artifact, produced by tremor, was so pronounced to be misdiagnosed and treated as ventricular tachycardia. CONCLUSION: This case highlights the importance of correlating ECG findings with history and clinical examination and of using 12 lead ECGs for rhythm interpretation especially to confirm consistence of arrhythmias in all leads.
