An unique case suffering from repetitive syncope episodes due to ictal asystole.

We present the case of a patient with syncope with repetition over 12 years, with a clinical profile not clearly related with a cardiogenic origin, who was studied by several medical specialties without any accurate diagnosis. After subcutaneous loop recorder implantation, we were able to demonstrate how seizures acted as a trigger in the genesis of an exaggerated cardio inhibitory reflex. A new entity has been described, known as "ictal asystole", in patients with focal epilepsy mostly from the temporal lobes and has been implicated as a cardiac cause of sudden unexplained death in epilepsy.

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Objective: To determine the occult mortality in the extra-hospital setting.

Patients And Method: Retrospective study included patients who required health care using the Andalusian Emergency Services from January 2002 to June 2002 and who remained at home or were transferred to an Emergency department of a hospital in a normal ambulance as they were not considered to be in need of emergency assistance.

Results: Of the 562 patients who met the inclusion criteria of this study, 17 patients died after this care, which was an occult mortality of 3%, 8 of whom had remained at home.