Background: Partial and generalized epileptic seizures frequently cause central dysautonomia. Sympathomimetic response is seen most frequently – ictal tachycardia occurs in more than 85% of cases, ictal bradycardia in less than 2% of patients, while epileptogenic asystole is very rare, and occasionally related to the underlying cardiac condition. Antiepileptic medications can also modulate autonomic function and arrhythmogenesis. (1, 2)

Case report: 44-year-old patient with long-lasting focal epilepsy with complex symptomatology and secondary generalization, with no previous history of heart disease, has been referred to ambulatory 24-hour Holter ECG monitoring. Sinus bradycardia with minimal heart rate of 19/min and sinus pauses up to 5.0 seconds was detected in sleep. Period of bradycardia ensued between significant technical interference caused by tonic-clonic seizures.

Conclusion: Cardiovascular dysfunction can contribute to sudden death in epilepsy, therefore increased awareness and timely detection of concomitant arrhythmias is essential. Simultaneous video-electroencephalography and electrocardiographic monitoring is a diagnostic method of choice.