Complete heart block mimicking seizure disorder

Area of Science:

• Cardiology
• Neurology

Background:

• Seizures can be a symptom of cardiac arrhythmias.
• Stokes-Adams attacks, characterized by syncope and seizures, are often caused by transient cardiac asystole.

Purpose of the Study:

• To describe two cases of seizures secondary to complete heart block with ventricular asystole.
• To highlight the long-term cardiac conduction abnormalities following such episodes.

Main Methods:

• Case report of two patients presenting with seizures.
• Electrocardiogram (ECG) to diagnose cardiac rhythm abnormalities.
• Temporary transvenous pacing for acute management.

Main Results:

• Both patients presented with seizures attributed to complete heart block and ventricular asystole (4-10 seconds).
• Temporary transvenous pacing successfully controlled the Stokes-Adams episodes.
• Both patients exhibited persistent right bundle branch block (RBBB) and left anterior hemiblock (LAH) 1.5 years post-event.

Conclusions:

• Seizures can be a manifestation of severe cardiac conduction disturbances like ventricular asystole.
• While temporary pacing can effectively manage acute Stokes-Adams episodes, underlying conduction defects may persist.
• Long-term monitoring for arrhythmias and conduction abnormalities is crucial in patients with a history of such events.