A subgroup of patients with epilepsy die suddenly and ictal bradycardia (IB) has been implicated. We describe a 63‐year‐old man with diagnosis of refractory epilepsy. The patient had long video and EEG/ECG recordings (48 hours) of wakefulness and abnormal sleep due to the presence of seven ictal events, which are associated with complex partial seizures that start on the temporal region. The patient presented a severe dysautonomia ictal, at 10–15 seconds of the start of the event is observed bradycardia and after 25 seconds occurs asystole for 15 seconds. Dual‐chamber pacemaker was implanted with improvement.
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