Two cases of young children with frequent severe breath-holding spells complicated by prolonged asystole and seizures are reported. A ventricular pacemaker was implanted in each child, and both have subsequently remained free of syncope, although they continue to exhibit breath-holding behaviour.Key Words: Asystole; Breath-holding; Pacemaker; Syncope Un stimulateur en cas d'asystolie dans les spasmes du sanglotOn rend compte du cas de deux jeunes enfants présentant des spasmes du sanglot fréquents et graves, compliqués par une asystolie prolongée et des convulsions. Un stimulateur ventriculaire a été implanté chez chaque enfant, et si tous deux ont continué à faire des spasmes du sanglot, ils n'ont plus fait de syncopes. B reath-holding spells (BHS) are common in early childhood, typically occurring between the ages of six months and four years. Severe pallid spells and, less commonly, cyanotic spells may be complicated by the loss of consciousness, posturing and generalized seizures. A toddler and an infant who experienced prolonged asystole at the time of severe BHS and who were treated with the implantation of ventricular pacemakers are described. CASE 1 PRESENTATIONAn 18-month-old "determined and busy" girl was referred to the cardiology clinic with a history of syncope since the age of 11 months. All events were precipitated by the child being upset, usually when something was taken away from her without warning or when she experienced a minor injury. The child would cry hard; become cyanotic; stop breathing on expiration; turn silent, pale and limp; and lose consciousness. She would recover with an inspiratory gasp within a few minutes. The parents documented 49 BHS. On four occasions, the child developed opisthotonic posturing and myoclonic jerks. Twice the pupils became dilated and she became incontinent. Her tone and skin colour improved gradually over several minutes. Spells were followed by at least one-and-a-half hours of sleep. When the parents learned about asystole associated with breath-holding, they treated the individual episodes with oxygen, res-

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