title: Complete heart block with ventricular asystole during left vagus nerve stimulation for epilepsy.
abstract: Vagus nerve stimulation (VNS) is an important therapeutic option for individuals with refractory epilepsy who have failed multiple antiepileptic drugs (AEDs). The intricate relationship of the vagus nerve to cardiac function raises concern that vagal stimulation may affect cardiac rhythm and function. Previous pre- and postmarketing studies have not shown this to be a significant problem, with the incidence of bradyarrhythmias reported to be about 0.1%. We review three cases of ventricular asystole with complete heart block that occurred during intraoperative lead tests. The purpose of these case reports is to identify the specific type of cardiac abnormality associated with vagus nerve stimulation and to identify individuals at risk.
authors.affiliation: Department of Neurology, Medical College of Ohio, Toledo, OH 43614, USA. iali@mco.edu <iali@mco.edu>
authors.forename: Imran I
authors.initials: II
authors.lastname: Ali
authors.forename: Noor A
authors.initials: NA
authors.lastname: Pirzada
authors.forename: Yousuf
authors.initials: Y
authors.lastname: Kanjwal
authors.forename: Braxton
authors.initials: B
authors.lastname: Wannamaker
authors.forename: Azedine
authors.initials: A
authors.lastname: Medhkour
authors.forename: Michael T
authors.initials: MT
authors.lastname: Koltz
authors.forename: Bradley V
authors.initials: BV
authors.lastname: Vaughn
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D048909:Diabetes Complications; D004351:Drug Resistance; D004599:Electric Stimulation Therapy / Q000009:adverse effects* / Q000295:instrumentation; D004567:Electrodes, Implanted; D004827:Epilepsy / Q000150:complications* / Q000628:therapy*; D006323:Heart Arrest / Q000209:etiology*; D006327:Heart Block / Q000209:etiology*; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D014630:Vagus Nerve / Q000502:physiology*
chemical_list: D000927:Anticonvulsants