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Europace Advance Access originally published online on January 9, 2006
Europace 2006 8(2):128; doi:10.1093/europace/euj031
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

SYNCOPE

Accelerated sinus rhythm with high grade A-V block during head-up tilt testing

K.E. Paravolidakis1,*, T.S. Apostolou1, G.N. Theodorakis2, V.G. Vartela1 and D.TH. Kremastinos2

Second Department of Cardiology Nikea General Hospital, Athens Greece ; Second Department of Cardiology Onassis Cardiac Surgery Center, 356 Syngrou Avenue, 17674 AthensGreece

Manuscript submitted 15 February 2005. Accepted after revision 18 October 2005.

Corresponding author. Tel: +30 210 9493 372; fax: +30 210 9493 373. E-mail address: kparavol{at}yahoo.gr

A 42-year-old man was admitted to our department owing to recurrent (~5) episodes of loss of consciousness, during the previous month. The patient underwent a head-up tilt testing after a full diagnostic evaluation (clinical examination, 24 h Holter ECG recordings, electrophysiologic test) was completely normal.

During 60° head-up tilt testing syncope occurred in conjunction with a very unusual presentation.1Go There was an acceleration of the heart rate from 72 to ~130 bpm as demonstrated in the top panel (Fig. 1). Thereafter, the ventricular response decreased (second panel), and within 30 s, there was high-grade A-V block, whereas the sinus rate remained unchanged (third panel). A decrease of blood pressure was noticed at the same time leading to the develop- ment of frank syncope. The whole episode lasted about 50 s followed by complete recovery and resumption of 1:1 A-V conduction (bottom panel).


Figure 0311
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  		Figure 1 ECG recording during head-up tilt testing.

 
The latest ACC/AHA guidelines for pacemaker implantation in cases of vasovagal syncope are class IIa, level of evidence B.2Go A dual-chamber pacemaker programmed in the DDD mode, with hysteresis, was implanted in our patient, who has remained asymptomatic for 1 year.


   References
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 References
 
[1] Sra JS, Singh B, Blanck Z, et al. Sinus tachycardia with atrioventricular block: an unusual presentation during neurocardiogenic (vasovagal) syncope. J Cardiovasc Electrophysiol 1998; 9: 203–7.[Medline]

[2] Gregoratos G, Abrams J, Epstein AE, et al. ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices—summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines). J Am Coll Cardiol 2002; 40: 1703–19.[Free Full Text]


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