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Initiation of levetiracetam was recommended for 6\u2009months, and after undergoing dual-chamber pacemaker placement, her neurological symptoms resolved despite persistent hyperemesis during the first trimester, leading to a successful vaginal delivery. 4 years later, the patient remains asymptomatic. This case emphasises the importance of conducting a thorough differential diagnosis in patients with atypical seizure presentations, the multidisciplinary approach required to assure optimal outcomes in cardio-obstetric cases and the role of selective pacemaker placement in patients with documented prolonged ventricular asystole associated with CMVS.<\/jats:p>","DOI":"10.1136\/bcr-2024-261568","type":"journal-article","created":{"date-parts":[[2024,11,12]],"date-time":"2024-11-12T13:05:22Z","timestamp":1731416722000},"page":"e261568","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond Seizures: the enigma of cardioinhibitory malignant vasovagal syncope in a complicated pregnancy journey"],"prefix":"10.1136","volume":"17","author":[{"given":"Juan G","family":"Sierra","sequence":"first","affiliation":[{"name":"Cardiology, Naples Community Hospital Healthcare System, Naples, Florida, 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