Ictal bradyarrhythmia (IB) and ictal asystole (IA) are rare complications of epilepsy. Onset latency of IB/IA implicates central nervous parasympathetic pathways, causing asystole, subsequent cerebral hypoxaemia, and potentially inducing a paradoxal, therapeutic effect by terminating both the seizure and the IA. This is a case report of a 68-year-old woman with mesial temporal lobe epilepsy and hippocampal sclerosis and IA. Association of IB/IA and sudden unexpected death in epilepsy lacks evidence and pacemaker therapy is rarely indicated. Treatment aims to minimize seizures and reduce the risk of falls.