Key result
Permanent pacemaker implantation resolves syncope in ~100% of patients with paroxysmal pause-dependent AV block.
Why the study?
Pause-dependent AV block is a frequently under-recognized cause of syncope and cardiac arrest characterized by abrupt, transient conduction failure with ventricular standstill that may mimic neurological or vasovagal events.
Does permanent pacemaker implantation resolve syncope symptoms in patients with paroxysmal pause-dependent atrioventricular block?
Case Report (n=4)
Yes
Does permanent pacemaker implantation resolve syncope symptoms in patients with paroxysmal pause-dependent atrioventricular block?
Prolonged rhythm monitoring is essential to capture paroxysmal pause-dependent AV block in patients with unexplained syncope, as permanent pacing is curative and prevents sudden cardiac death.
Answers are grounded in this paper and cite their sources.
Supports pacing consideration in pause-dependent AV block syncope; leaves open generalizability pending larger prospective studies.
BACKGROUND: Pause-dependent atrioventricular (AV) block is a cause of syncope and cardiac arrest characterized by abrupt but transient conduction failure with ventricular standstill despite previous AV conduction. It is frequently under-recognized. CASE SUMMARY: We describe 4 patients presenting with syncope. Baseline electrocardiograms were nondiagnostic, but continuous monitoring captured episodes of sudden high-grade AV block initiated by pauses or premature beats, without progressive PR prolongation. All patients underwent permanent pacemaker implantation, with resolution of symptoms during follow-up. DISCUSSION: Pause-dependent AV block is thought to arise from the inability of diseased His-Purkinje tissue to sustain its resting potential during phase 4 of the cardiac action potential. It may mimic neurological or vasovagal events. Diagnosis depends on timely rhythm documentation. Early recognition is essential because pacing is highly effective in preventing recurrence. TAKE-HOME MESSAGES: Syncope with suspicion for a cardiac cause should prompt prolonged monitoring. Pacing of pause-dependent paroxysmal AV block can prevent further events.
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Kwan et al. (2026) conducted a case report in Paroxysmal pause-dependent atrioventricular (AV) block (n=4). Permanent pacemaker implantation was evaluated on Resolution of syncope symptoms. Permanent pacemaker implantation resolved syncope symptoms in all 4 patients diagnosed with paroxysmal pause-dependent atrioventricular block via continuous monitoring.
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