A pacemaker for asystole in breath-holding spells

Area of Science:

• Pediatric Cardiology
• Neurology
• Cardiac Electrophysiology

Background:

• Breath-holding spells are common in children, typically benign.
• Severe spells can rarely lead to asystole, syncope, and seizures.
• The cardiac and neurological interplay in severe breath-holding spells requires further investigation.

Observation:

• Two young children presented with frequent, severe breath-holding spells.
• These spells were complicated by prolonged asystole and seizures.
• Standard treatments had limited efficacy.

Findings:

• Ventricular pacemaker implantation was performed in both children.
• Following implantation, both patients remained free of syncope.
• The underlying breath-holding behavior persisted despite pacemaker use.

Implications:

• Pacemaker implantation is a viable treatment for severe, life-threatening breath-holding spells with asystole.
• This intervention can prevent syncope and associated neurological complications.
• Further research into the mechanisms of breath-holding spells and cardiac involvement is warranted.