Intermittent Complete Atrioventricular Block with Syncope: A Case Report

Syncope is a common emergency condition, which accounts for 3% of emergency room visits. The etiology of syncope is complicated and most of the presentation is paroxysmal. Thus, it is extremely challenging for the physicians to establish the cause of syncope. A 71-year-old man with recurrent of attack syncopeis reported here. In his initial presentation, all basic studies including 24 hours ambulatory electrocardiogram (ECG) monitoring, echocardiography, brain computed tomographic (CT), electroencephalogram (EEG), transcranial duplex imaging and tilt table test, were negative except ECG found bifascicular block. At a subsequent syncopal attack, 24 hours ambulatory ECG was repeated and found intermittent complete atrioventricular block with prolonged ventricular asystole up to 19.4 sec. The patient recalled black out of bilateral vision and chest tightness when he was sitting and watching TV at this period. He received a VDD pacemaker implantation and became symptom free during the follow up period.