The treatment of ictal asystole with cardiac pacing

Ictal asystole may contribute to seizure-related injury and mortality. The purpose of this study was to evaluate the effect of cardiac pacing on seizure-related injury rates in ictal asystole patients. A survey was conducted to determine seizure-related fall rate and other morbidity in all seven patients with ictal asystole who underwent cardiac pacing at our institution between 1990 and 2004. The rate of seizure-related falls and other morbidities before and after pacing were compared using the Wilcoxon rank-sum test. The mean fall rate was 3.28 falls/month pre-pacemaker implantation. Following pacemaker implantation, this was reduced to 0.005 falls/month (p = 0.001). Seizure-related fractures and motor vehicle accidents were also reduced following cardiac pacing. These findings may have implications in mitigating the potential morbidity associated with ictal asystole.