Seizure-related cardiac arrhythmias are frequently reported and have been 
implicated as potential pathomechanisms of Sudden Unexpected Death in Epilepsy 
(SUDEP). We attempted to identify clinical profiles associated with various 
(post)ictal cardiac arrhythmias. We conducted a systematic search from the first 
date available to July 2013 on the combination of two terms: 'cardiac 
arrhythmias' and 'epilepsy'. The databases searched were PubMed, Embase (OVID 
version), Web of Science and COCHRANE Library. We attempted to identify all case 
reports and case series. We identified seven distinct patterns of (post)ictal 
cardiac arrhythmias: ictal asystole (103 cases), postictal asystole (13 cases), 
ictal bradycardia (25 cases), ictal atrioventricular (AV)-conduction block (11 
cases), postictal AV-conduction block (2 cases), (post)ictal atrial 
flutter/atrial fibrillation (14 cases) and postictal ventricular fibrillation (3 
cases). Ictal asystole had a mean prevalence of 0.318% (95% CI 0.316% to 0.320%) 
in people with refractory epilepsy who underwent video-EEG monitoring. Ictal 
asystole, bradycardia and AV-conduction block were self-limiting in all but one 
of the cases and seen during focal dyscognitive seizures. Seizure onset was 
mostly temporal (91%) without consistent lateralisation. Postictal arrhythmias 
were mostly found following convulsive seizures and often associated with (near) 
SUDEP. The contrasting clinical profiles of ictal and postictal arrhythmias 
suggest different pathomechanisms. Postictal rather than ictal arrhythmias seem 
of greater importance to the pathophysiology of SUDEP.