Iatrogenic ictal asystole

Background: Sodium channels blockers are widely used in focal epilepsies. Beyond frequent and recognized adverse events, a possible influence in cardiac conduction has rarely been hypothesized. Cardiac asystolia is a rare complication of seizures: exact etiology is far from being clarified. Method and results: Here we report two cases of focal pharmacoresistant epilepsy complicated by ictal asystole which occurred only in the course of treatment with carbamazepine and phenytoin. Conclusions: The clear relationship between ictal arrhythmia and sodium channels blockers may be related to the negative chronotropic and inotropic cardiac effects. Ictal asystole may exacerbate falls in epileptic populations and requires rapid therapeutic decisions. Iatrogenic causes must be added in the therapeutic algorithm.