What can happen to the heart during video EEG recordings?

The cerebral regions which are involved in the regulation of cardiac autonomic function, including insular cortex, cingulate gyrus, amygdala and hippocampus, are frequently affected by seizure activity, leading to manifold cardiac signs and symptoms in association with epileptic seizures. Sinus tachycardia is the most frequent cardiac expression of epileptic seizures, of benign nature and useful in wearable seizure detection devices. In contrast, ictal asystole is a rare phenomen which occurs almost exlusively with temporal lobe seizures. Although self-limiting, ictal asystole may be linked to syncope with flaccid falls and injuries. Ictal asystole tends to recur in the same patients, suggesting implantation of cardiac pacemaker if seizure-freedom cannot be achieved. Postictal asystole is also a rare complication of epileptic seizures and appears to occur exclusively following tonic-clonic seizures. In contrast to ictal asystole, postictal asystole is not directly caused by cerebral mechanisms, but secondary to central apnoea and subsequent severe hypoxemia. Postictal asystole is probably the most frequent cause of sudden unexpected death in epilepsy (SUDEP) and may be prevented by early cardiac resuscitation. Postictal ventricular tachycardia was very rarely described following tonic-clonic seizures, and is probably linked to seizure-related alterations of cardiac repolarisation properties.