Adams-Stokes attack with delayed heart block after ventricular septal repair

A child with Down syndrome, who had undergone uneventful ventricular septal defect repair one year earlier with a normal heart rate during routine follow-up, presented with recurrent seizure-like episodes that did not respond to antiepileptics. She was subsequently found to have complete heart block with significant bradycardia requiring permanent pacemaker insertion. This late and unusual presentation of complete heart block after ventricular septal defect repair is discussed. Prudence must be applied in the evaluation of children who have undergone surgical correction of congenital heart defects and presented with recurrent seizure-like episodes.