Case report: Vagal nerve stimulation and late onset asystole

Shankar, Rohit; Olotu, Victor; Cole, Nicholas J.; Sullivan, Heather; Jory, Caryn

doi:10.1016/j.seizure.2012.12.011

Cited by 17 publications

(18 citation statements)

References 11 publications

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“…Cardiac symptoms were noted after 2.33-9 years postimplantation [1][2][3][4]. Three cases had symptoms correlated with stimulation, monitored by electrocardiogram [1,2,4]. This new case report highlights cardiac syncope with very similar clinical presentation as previous four cases, and raises the concern for cardiac symptoms, even many years after VNS implantation.…”

Section: Introductionsupporting

confidence: 51%

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Vagus nerve stimulation and late-onset bradycardia and asystole: Case report

Pascual

2015

Seizure

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Section: Introductionsupporting

confidence: 51%

“…Their ages were 13, 17, 47, and 55. Cardiac symptoms were noted after 2.33-9 years postimplantation [1][2][3][4]. Three cases had symptoms correlated with stimulation, monitored by electrocardiogram [1,2,4].…”

Section: Introductionmentioning

confidence: 99%

Vagus nerve stimulation and late-onset bradycardia and asystole: Case report

Pascual

2015

Seizure

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“…All clinical data are shown in Table 1 . The 22 patients [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] in the arrhythmia group comprised of 8 females and 16 males (mean age, 39 years; range, 8–59 years), while the 29 patients in the control group comprised of 11 females and 18 males (mean age, 31 years; range, 9–52 years). The arrhythmia group was significantly older than the control group (p = 0.038).…”

Section: Resultsmentioning

confidence: 99%

New onset syncopal events following vagus nerve stimulator implantation might be key to preventing vagus nerve stimulation-induced symptomatic bradycardia — A case report and review

Kato

Fujimoto

Okanishi

et al. 2018

Epilepsy & Behavior Case Reports

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PurposeTo identify risk factors for VNS-associated arrhythmia.MethodsA literature review identified 14 papers with 21 patients. We compared patients with VNS associated arrhythmia (arrhythmia group, n = 22) and patients without VNS associated arrhythmia (control group of our VNS implanted patients, n = 29).ResultsNew onset syncopal events following VNS placement were seen in the arrhythmia group (p < 0.001).ConclusionEven though arrhythmia could be symptomatic, most cases associated with syncope were treated as new-onset epileptic seizures with adjustment of anti-seizure drugs. To detect cardiac asystole during VNS treatment, clinicians should be alert to the possibility of new onset syncopal events that differ from habitual seizures.

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“…Multiple case reports have described intraoperative and postoperative bradycardia, asystole, and arrhythmias associated with VNS placement and activation [7,8,10]. These symptoms have been attributed to stimulation of descending parasympathetic fibers in the left vagus nerve that innervate the sinoatrial (SA) node.…”

Section: Discussionmentioning

confidence: 99%

“…The more serious side effects that have been reported include bradycardia and asystole. For these symptoms, an intraoperative screening is routinely performed and, if absent, such cardiac effects have rarely recurred [4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Pseudoanginal chest pain associated with vagal nerve stimulation: a case report

et al. 2020

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Background: Vagal nerve stimulation (VNS) can be an effective therapy for patients with epilepsy refractory to antiepileptic drugs or intracranial surgery. While generally well tolerated, it has been associated with laryngospasm, hoarseness, coughing, dyspnea, throat and atypical chest pain, cardiac symptoms such as bradycardia and occasionally asystole. We report on a patient receiving vagal nerve stimulation who experienced severe typical anginal chest pain during VNS firing without any evidence of cardiac ischemia or dysfunction. Thus, the pain appeared to be neuropathic from the stimulation itself rather than nociceptive secondary to an effect on heart function. Case presentation: A 29-year-old man, with a history of intractable frontal lobe epilepsy refractory to seven antiepileptic medications and subsequent intracranial surgery, underwent VNS implantation without complications. On beginning stimulation, he began to have intermittent chest pain that corresponded temporally to his intermittent VNS firing. The description of his pain was pathognomonic of ischemic cardiac chest pain. On initial evaluation, he displayed Levine's sign and reported crushing substernal chest pain radiating to the left arm, as well as shortness of breath walking upstairs that improved with rest. He underwent an extensive cardiac workup, including 12-lead ECG, cardiac stress test, echocardiogram, 12-day ambulatory cardiac monitoring, and continuous ECG monitoring each with and without stimulation of his device. The workup was consistently negative. Inability to resolve the pain necessitated the disabling and eventual removal of the device. Conclusion: To our knowledge, this is the first report of pseudoanginal chest pain associated with VNS. This occurrence prompted our review of the mechanisms of cardiac chest pain and suggests that vagal afferents may convey anginal pain separately or in parallel with known spinal cord pain mechanisms. These insights into the physiology of chest pain may be of general interest and important to surgeons implanting VNS devices who may potentially encounter such symptoms.

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Case report: Vagal nerve stimulation and late onset asystole

Cited by 17 publications

References 11 publications

Vagus nerve stimulation and late-onset bradycardia and asystole: Case report

Vagus nerve stimulation and late-onset bradycardia and asystole: Case report

New onset syncopal events following vagus nerve stimulator implantation might be key to preventing vagus nerve stimulation-induced symptomatic bradycardia — A case report and review

Pseudoanginal chest pain associated with vagal nerve stimulation: a case report

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