Highlights the importance of ruling out AV conduction disease as a cause of syncope in patients with AF and controlled rates, particularly unmasking trifascicular block post DC cardioversion.
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May indicate unmasked trifascicular block post-DC cardioversion in AF syncope; hypothesis-generating and requires confirmation before clinical adoption.
We present a 51 years old male patient with recurrent syncope. Patient had baseline RBBB, LAFB and atrial fibrillation with normal holter study for 24 h period. Post DC cardioversion he went to first degree AV block in addition to baseline RBBB + LAFB, an evidence of trifascicular block. This was confirmed on EP study and patient underwent permanent pacemaker implantation. Doing well on follow up. The moral of story is that if a patient has AF with controlled rates, AV conduction disease should be ruled out as a cause for syncope and we should not ignore the facts about rhythm disturbances which can be seen post DC cardioversion of AF.
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Mahla et al. (2015) studied this question.
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