{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T15:40:12Z","timestamp":1790782812371,"version":"4.1.0"},"reference-count":15,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,3,4]],"date-time":"2022-03-04T00:00:00Z","timestamp":1646352000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,3,4]],"date-time":"2022-03-04T00:00:00Z","timestamp":1646352000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Neurol"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Vagal nerve stimulation (VNS) is approved therapy for the treatment of intractable epilepsy. The stimulation of either nerve, left or right, is effective. However, due to the anatomic and physiological effects of cardiac innervation, the right vagus nerve is typically avoided in order to minimize the risk of cardiac bradyarrhythmias. The location of the VNS lead contacts on the nerve can also have an effect, namely, more distally placed contacts have been associated with lower risk of cardiac arrhythmias, presumably by avoiding vagal cervical cardiac branches; however, our case demonstrates reproducible asystole despite left sided, distal VNS lead placement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We report a 28-year-old male patient with pharmacoresistant generalized clonic-tonic seizures. The VNS therapy with 1.5\u00a0mA output and 16% duty cycle drastically reduced his seizure burden for several years. The breakthrough seizures along with stabbing pain episodes at the implantable pulse generator (IPG) site have prompted the VNS lead revision surgery with new lead contacts placed more caudally than the old contacts. However, the intraoperative device interrogation with 1\u00a0mA output resulted in immediate asystole for the duration of stimulation and it was reproducible until the output was decreased to 0.675\u00a0mA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our case highlights the possibility of new severe cardiac bradyarrhythmias following surgical VNS lead replacements even in patients without preoperatively known clinical side effects. We suggest preoperative electrocardiography and cardiology consultation for detected abnormalities for all patients undergoing new VNS implantations, as well as revision surgeries for VNS malfunctions. Intraoperatively, the surgeon and anesthesia team should be vigilant of cardiac rhythms and prepared for the immediate management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12883-022-02585-6","type":"journal-article","created":{"date-parts":[[2022,3,4]],"date-time":"2022-03-04T08:38:28Z","timestamp":1646383108000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Reproducible asystole following vagal nerve stimulator lead replacement: a case report"],"prefix":"10.1186","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9964-0187","authenticated-orcid":false,"given":"Hayden","family":"Scott","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Moore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hakan","family":"Paydak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelsey","family":"Hundley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viktoras","family":"Palys","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,3,4]]},"reference":[{"issue":"6","key":"2585_CR1","doi-asserted-by":"publisher","first-page":"514","DOI":"10.1016\/S1474-4422(08)70108-X","volume":"7","author":"SU Schuele","year":"2008","unstructured":"Schuele SU, L\u00fcders HO. Intractable epilepsy: management and therapeutic alternatives. Lancet Neurol. 2008;7(6):514\u201324.","journal-title":"Lancet Neurol"},{"issue":"12","key":"2585_CR2","doi-asserted-by":"publisher","first-page":"669","DOI":"10.1038\/nrneurol.2012.181","volume":"8","author":"S Wiebe","year":"2012","unstructured":"Wiebe S, Jette N. Pharmacoresistance and the role of surgery in difficult to treat epilepsy. Nat Rev Neurol. 2012;8(12):669\u201377.","journal-title":"Nat Rev Neurol"},{"issue":"2","key":"2585_CR3","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1007\/s40473-014-0010-5","volume":"1","author":"RH Howland","year":"2014","unstructured":"Howland RH. Vagus Nerve Stimulation. Curr Behav Neurosci Rep. 2014;1(2):64\u201373.","journal-title":"Curr Behav Neurosci Rep"},{"key":"2585_CR4","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1016\/j.seizure.2015.01.006","volume":"26","author":"FT Pascual","year":"2015","unstructured":"Pascual FT. Vagus nerve stimulation and late-onset bradycardia and asystole: Case report. Seizure. 2015;26:5\u20136.","journal-title":"Seizure"},{"issue":"4","key":"2585_CR5","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1016\/j.seizure.2012.12.011","volume":"22","author":"R Shankar","year":"2013","unstructured":"Shankar R, Olotu VO, Cole N, Sullivan H, Jory C. Case report: Vagal nerve stimulation and late onset asystole. Seizure. 2013;22(4):312\u20134.","journal-title":"Seizure"},{"issue":"2","key":"2585_CR6","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1007\/s10286-017-0477-8","volume":"29","author":"I Garamendi-Ruiz","year":"2019","unstructured":"Garamendi-Ruiz I, G\u00f3mez-Esteban JC. Cardiovascular autonomic effects of vagus nerve stimulation. Clin Auton Res. 2019;29(2):183\u201394.","journal-title":"Clin Auton Res"},{"key":"2585_CR7","unstructured":"Mandoorah S, Mead T. Phrenic Nerve Injury. StatPearls [Internet]. 2021 Aug 13 [cited 2022 Jan 7]; Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK482227\/"},{"issue":"5","key":"2585_CR8","doi-asserted-by":"publisher","first-page":"535","DOI":"10.3171\/2014.10.PEDS14259","volume":"15","author":"CV Gopalakrishnan","year":"2015","unstructured":"Gopalakrishnan CV, Kestle JRW, Connolly MB. The \u201cvagal ansa\u201d: a source of complication in vagus nerve stimulation. J Neurosurg Pediatr. 2015;15(5):535\u20138 cited 2022 Jan 16. Available from:https:\/\/thejns.org\/pediatrics\/view\/journals\/j-neurosurg-pediatr\/15\/5\/article-p535.xml.","journal-title":"J Neurosurg Pediatr"},{"issue":"4","key":"2585_CR9","doi-asserted-by":"publisher","first-page":"928","DOI":"10.1111\/j.1528-1167.2008.01918.x","volume":"50","author":"J Iriarte","year":"2009","unstructured":"Iriarte J, Urrestarazu E, Alegre M, Mac\u00cdas A, G\u00f3mez A, Amaro P, et al. Late-onset periodic asystolia during vagus nerve stimulation. 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A copy of the written consent is available for review by the editor of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"75"}}