Temporary atrial fibrillation associated with generalized tonic clonic seizures in a not known epileptic Caucasian male: two unrelated episodes or a temporary autonomic neurocardiac dysfunction caused by the seizure? A case report and a review of literature

We describe a case of a 44-years-old Caucasian male admitted in 23/8/2023 for syncope without prodromes nor red flags symptoms associated with tonic-clonic movements likely. Patient complained that in 3 days before syncope had general discomfort. He is a known hypertensive in therapy and a smoker; family history for epilepsy and past medical history for seizures or recent head trauma were negative. First medical examination in our Emergency ward was negative except for a morsus evidence. ECG did not show a ACS pattern nor PE findings. POCUS was performed with no signs of aortic dissection, nor cardiac dyskinesis or pericardial tamponade. Blood examination were suspected for seizures due to elevation of CPK, no metabolic causes were noted. A head CT was performed showing no sign of recent ischemic lesions nor hemorrhages. During his stay in our emergency ward, our patient develop a generalized tonic clonic seizure. After stopping the seizure with midazolam, our patient developed a high frequency atrial fibrillation. It was started a rate control therapy (first with digossine than with beta blocker) due to no history of palpitations, patient was continuous monitored. The following day patient presented a normal synus rhythm and was discharged with starting of levetiracetam. A cardiological and neurological follow-up where planned. Epileptic seizures are often associated with changes in cardiac autonomic function. The most widely described change is tachyarrhythmia. Despite the fact that atrial arrhythmias are the most common types of arrhythmia, atrial fibrillation has only rarely been associated with epileptic seizures.