80yo man for L TKR. 

Issues:

• Episode of LOC several years ago
• Isolated event. Nil seizure-like features.
• Witnessed by family members
• Extensive review by neurologist – EEG showed prominent epileptiform features in the temporal lobe which were reproducible on repeat testing. 
• EEG abnormalities resolved with commencement of Levetiracetam. 

• Bifascicular block on ECG, HR 59, no cardiologist review

Discussion

Should we be concerned about a cardiac cause for his LOC?

• Reassuring features:
  • One distant episode. 
  • Now treated for epilepsy. No further episodes.
  • EEG showed a gross abnormality and repeat EEG after treatment was normal.
• Concerning features:
  • Episode doesn’t really sound like a seizure. Sounds more cardiac in origin.
• Unlikely that a cardiologist be interested in one episode of LOC
• Holter = low risk study however likely wasted resource and burdensome to patient 

Plan:

• Proceed with surgery without further investigations.