Abstract
A 42-year-old woman was referred for cardiac diagnostic work-up of loss of recurrent consciousness over the past 25 years. She received medication with an anxiolytic, an antidepressant, and a neuroleptic drug. After a normal resting ECG, there were 112 episodes of paroxysmal atrioventricular block III° in her 24 h Holter recording with asystole for up to 27 s. The patient was symptomatic only once with dizziness due to an asystole of 8.8 s while she was awake in the early morning. After DDDR pacemaker implantation, the patient was asymptomatic during the following 2 years. This case illustrates the complex and not fully understood problem of paroxysmal AV block, in this instance neither intrinsic, nor phase 4 or vagally induced. It further reminds us to carefully clarify the cause of loss of consciousness consistently which may render prolonged ECG monitoring necessary also in patients without heart disease.
Zusammenfassung
Eine 42-jährige Patientin wird zur kardiologischen Abklärung unklarer Bewusstseinsverluste seit 25 Jahren vorgestellt. Es erfolgte eine Medikation mit Anxiolytikum, Antidepressivum und Neuroleptikum. Bei unauffälligem Ruhe-EKG fanden sich im 24-Stunden-Langzeit-EKG 112 Phasen von paroxysmalem atrioventrikulärem Block III° mit Pausen bis zu 27 s. Die Patientin war einmalig symptomatisch mit Schwindel bei einer Pause von 8,8 s während einer Wachphase am frühen Morgen. Nach DDDR-Schrittmacher-Implantation war die Patientin in den folgenden 2 Jahren beschwerdefrei. Der Fall illustriert das nicht vollständig verstandene Bild des paroxysmalen AV-Blocks, der hier weder intrinsisch noch durch Phase-4-Block oder vagal verursacht wurde. Weiterhin mahnt er eindrücklich, eine unklare Bewusstlosigkeit konsequent abzuklären, wozu auch bei kardial Gesunden ein intensives EKG-Monitoring notwendig sein kann.
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S. Tribunyan, C.W. Israel and M. Martirosyan declare that they have no competing interests.
This article does not contain any studies with human participants or animals performed by any of the authors.
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Tribunyan, S., Israel, C.W. & Martirosyan, M. Perservative paroxysmal atrioventricular block. Herzschr Elektrophys 28, 335–339 (2017). https://doi.org/10.1007/s00399-017-0528-9
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DOI: https://doi.org/10.1007/s00399-017-0528-9