Ventricular asystole during vagus nerve stimulation for epilepsy in humans

Tatum, William O.; Moore, David; Stecker, Michael S.; Baltuch, Gordon H.; French, Joseph C.; Ferreira, José Alexandre; Carney, Peter M.; Labar, D. R.; Vale, Fernando Ĺ.

doi:10.1212/wnl.52.6.1267

Cited by 165 publications

(87 citation statements)

References 18 publications

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“…This phenomenon could be of central origin (5) mediated by vagal cardiac activation. In a similar manner, other authors reported how ventricular asystole can occur because of vagal activation in the operating room (18). Recently, altered postganglionic cardiac sympathetic innervation with a predominant parasympathetic cardiac activity was demonstrated in patients with TLE by using MIBG-SPECT and domain analysis of heart-rate variability (19,20).…”

Section: Discussionmentioning

confidence: 67%

Cardiac Asystole in Epilepsy: Clinical and Neurophysiologic Features

Rocamora¹,

Kurthen²,

et al. 2003

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Summary: Purpose: Cardiac asystole provoked by epileptic seizures is a rare but important complication in epilepsy and is supposed to be relevant to the pathogenesis of sudden unexplained death in epilepsy (SUDEP). We sought to determine the frequency of this complication in a population of patients with medically intractable epilepsy and to analyze the correlation between EEG, electrocardiogram (ECG), and clinical features obtained from long‐term video‐EEG monitoring.Methods: Retrospective analysis of the clinical records of hospitalized patients from May 1992 to June 2001 who underwent long‐term video‐/EEG monitoring.Results: Of a total of 1,244 patients, five patients had cardiac asystole in the course of ictal events. In these patients, 11 asystolic events, between 4 and 60 s long in a total of 19 seizures, were registered. All seizures had a focal origin with simple partial seizures (n = 13), complex partial seizures (n = 4), and secondarily generalized seizures (n = 2). One patient showed the longest asystole ever reported (60 s) because of a seizure. Cardiac asystole occurred in two patients with left‐sided temporal lobe epilepsy (TLE) and in three patients with frontal lobe epilepsy (FLE; two left‐sided, one bifrontal). Two patients reported previous cardiac disease, but only one had a pathologic ECG by the time of admission. Two patients had a simultaneous central ictal apnea during the asystole. None of the patients had ongoing deficits due to the asystole.Conclusions: These findings confirm that seizure‐induced asystole is a rare complication. The event appeared only in focal epilepsies (frontal and temporal) with a lateralization to the left side. A newly diagnosed or known cardiac disorder could be a risk factor for ictal asystole. Abnormally long postictal periods with altered consciousness might point to reduced cerebral perfusion during the event because of ictal asystole. Central ictal apnea could be a frequent associated phenomenon.

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Section: Discussionmentioning

confidence: 67%

Cardiac Asystole in Epilepsy: Clinical and Neurophysiologic Features

Rocamora¹,

Kurthen²,

et al. 2003

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“…Arrhythmia, including asystole and bradycardia, is an important but rare complication that has been reported in the literature. [3][4][5]35,40 Possible reasons for this phenomenon could be polarity reversal of the leads during implantation causing efferent instead of afferent stimulation, 44 indirect stimulation of the cervical cardiac nerves, technical malfunction of the device, or accidental over-manipulation of the nerve since placing the spiral (Cyberonics) lead around the nerve can be difficult due to anatomical variations. The CardioFit cuff lead is subjectively easier to apply because of its design and requires less manipulation of the vagus nerve as a whole.…”

Section: Discussionmentioning

confidence: 99%

Complications and safety of vagus nerve stimulation: 25 years of experience at a single center

Révész

Rydenhag

Ben‐Menachem

2016

PED

143

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OBJECTIVE The goal of this paper was to investigate surgical and hardware complications in a longitudinal retrospective study. METHODS The authors of this registry study analyzed the surgical and hardware complications in 247 patients who underwent the implantation of a vagus nerve stimulation (VNS) device between 1990 and 2014. The mean follow-up time was 12 years. RESULTS In total, 497 procedures were performed for 247 primary VNS implantations. Complications related to surgery occurred in 8.6% of all implantation procedures that were performed. The respective rate for hardware complications was 3.7%. Surgical complications included postoperative hematoma in 1.9%, infection in 2.6%, vocal cord palsy in 1.4%, lower facial weakness in 0.2%, pain and sensory-related complications in 1.4%, aseptic reaction in 0.2%, cable discomfort in 0.2%, surgical cable break in 0.2%, oversized stimulator pocket in 0.2%, and battery displacement in 0.2% of patients. Hardware-related complications included lead fracture/malfunction in 3.0%, spontaneous VNS turn-on in 0.2%, and lead disconnection in 0.2% of patients. CONCLUSIONS VNS implantation is a relatively safe procedure, but it still involves certain risks. The most common complications are postoperative hematoma, infection, and vocal cord palsy. Although their occurrence rates are rather low at about 2%, these complications may cause major suffering and even be life threatening. To reduce complications, it is important to have a long-term perspective. The 25 years of follow-up of this study is of great strength considering that VNS can be a life-long treatment for many patients. Thus, it is important to include repeated surgeries such as battery and lead replacements, given that complications also may occur with these surgeries.

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“…Similarly, no cardiac problems have been encountered when VNS is turned on for the first time in the outpatient setting, typically 2 weeks after implantation (22,23). However, transient asystole lasting 10 to 20 s has been reported during the implantation procedure in 8 patients out of the estimated 7000 patients who have been implanted (1.1 per 1000) (24). Each of these instances occurred in the operating room during the first diagnostic testing of the lead-the so-called lead test.…”

Section: Tolerability and Safetymentioning

confidence: 99%

Vagus Nerve Stimulation for the Treatment of Epilepsy

Schmidt¹

2001

Epilepsy & Behavior

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Ventricular asystole during vagus nerve stimulation for epilepsy in humans

Cited by 165 publications

References 18 publications

Cardiac Asystole in Epilepsy: Clinical and Neurophysiologic Features

Cardiac Asystole in Epilepsy: Clinical and Neurophysiologic Features

Complications and safety of vagus nerve stimulation: 25 years of experience at a single center

Vagus Nerve Stimulation for the Treatment of Epilepsy

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