Vagus nerve stimulation (VNS) shows long-term efficiency worldwide in most pharmacoresistant patients with epilepsy; however, there are still a small number of patients who are non-responders to VNS therapy. It has been shown that VNS treatment outcomes for drug-resistant epilepsy may be predicted by preoperative heart-rate variability measurements and that patients with epilepsy with ictal tachycardia (IT) during seizures have good responses to VNS. However, few studies have reported the efficacy of VNS in patients with epilepsy with ictal bradycardia (IB) or normal heart rate (HR), and none have explored the possible mechanisms of VNS efficacy based on different HR types. HR during seizures varies, and we presume that different HRs during seizures may impact the effects of VNS. It has been shown that blood pressure in the human body needs to be maintained through the arterial baroreflex (ABR). VNS efficacy in patients with epilepsy with IT, IB, and normal HR during seizures may be related to ABR. Mechanical signals generated by VNS are similar to the autonomic nerve pathways and, thus, we propose the hypothesis that different HRs during seizures can predict VNS efficacy in patients. If VNS is highly efficient in patients with IT during seizures, VNS in patients with a normal HR during seizures may be less efficient, and may even be inefficient in patients with IB during seizures.