Post-ictal atrial fibrillation detected during video-EEG monitoring: Case report, proposed physiopathologic mechanism and therapeutic considerations

Abstract

Cardiac arrhythmias are a frequent complication related to seizures [1]. Most are benign although some, such as high-grade atrioventricular block, asystole, atrial fibrillation (AF), and ventricular fibrillation are potentially harmful. Indeed, several studies suggest that cardiac dysfunction may be the primary underlying cause of sudden unexpected death in epilepsy (SUDEP). Post-ictal atrial fibrillation (PIAF) is a very rare cardiac arrhythmia associated with seizures, and its relevance is currently unknown. AF characteristics include: 1) irregular R-R intervals, 2) absence of distinct repeating P waves, and 3) erratic atrial activity [2]. Atrial flutter is differentiated from AF because of the characteristic “saw tooth” waves on the ECG instead of the chaotic atrial rhythm of the AF. In fact, there are only four reported cases of PIAF diagnosed during video-EEG monitoring (VEM) [1], [3], [4]. We report a case of PIAF identified during long-term VEM, with recurrent episodes corroborated by Holter-ECG monitoring