Abstracts

Rationale: It has long been known that there is an association between seizure episodes and cardiac arrhythmias, with the most common being ictal sinus tachycardia. In this case, we discuss a rare occurrence of prolonged atrial fibrillation (AF) following an ictal episode and analyze the duration of AF in Video Electroencephalogram (VEEG) confirmed seizure. Methods: Case report and literature review was performed. PubMed was searched utilizing the phrases “epilepsy or seizure AND cardiac arrhythmias”, “seizure AND atrial fibrillation”, “post ictal atrial fibrillation”. English articles published were analyzed to determine VEEG capture of the seizures and duration of post ictal atrial fibrillation. Results: The case discussed in this abstract is that of a 62-year-old female patient with past medical history significant for meningioma, which was resected in 2005 and Parkinson’s disease on Carbidopa-Levodopa, who had seizure onset at 51 years of age. She experienced a VEEG captured seizure, associated with atrial fibrillation with rapid ventricular response. The atrial fibrillation began 2 seconds after electrographic seizure onset and only spontaneously converted back to sinus rhythm 2 days later. Prior to VEEG monitoring, the patient reported frequent chest palpitations lasting a day or more following seizure events. The nature of these cardiac arrhythmias was undiagnosed until VEEG.The results of the PubMed search yielded 480 articles. Among these articles, 16 cases reported post ictal atrial fibrillation or flutter. Of the 16 cases, 5 cases had VEEG confirmed seizures with post ictal AF. Of the 5 cases, the duration of the AF ranged from 10 seconds to 4 minutes 40 seconds, with an average of 1 minute 54 seconds. Conclusions: This case demonstrates a rare instance of post ictal AF sustained for 2 days. This case raises the question of whether or not similar patients may be at risk for thromboembolic events. It would be interesting to see if such patients may benefit from further long-term cardiac monitoring and prophylaxis for embolism with anticoagulation or the Watchman device, even if the arrhythmias were only following a seizure. Aggressive management with antiepileptic drugs to reduce seizures with cardiac arrhythmias may be crucial. This is an unusual case as literature search does not reveal any other case of such a prolonged post ictal atrial fibrillation. Funding: No funding