Prolonged post-ictal atrial fibrillation following seizures

It is well known that several types of cardiac arrhythmias can occur after a seizure, with ictal sinus tachycardia being the most common. However, post-ictal atrial fibrillation (PIAF) is a rare phenomenon with significant clinical implications. We describe the case of an epilepsy patient with prolonged PIAF. Our case is that of a 62-year-old female with seizure onset at 51 years of age. She had a left hemispheric meningioma that was resected with ongoing seizures. She described frequent episodes of chest fluttering lasting for several hours post-ictally. During video-EEG monitoring (VEEG), she had a typical seizure with staring and word finding difficulty. This was associated with the occurrence of atrial fibrillation with rapid ventricular rate that lasted 18 hours. We discuss the relation between seizures and prolonged PIAF as it relates to the need for anticoagulation, use of appropriate antiseizure medications, and the possible association with SUDEP.