Electrocardiographical case. Young woman with frequent syncope attacks

Area of Science:

• Cardiology
• Electrophysiology

Background:

• A 29-year-old woman presented with frequent syncope, initially suspected to be related to ventricular arrhythmias originating from the right ventricular outflow tract.
• Differential diagnoses included right ventricular outflow tract tachycardia, arrhythmogenic right ventricular dysplasia, and neurocardiogenic syncope.

Observation:

• During a tilt table test, the patient exhibited a malignant cardioinhibitory response, leading to abrupt syncope and a prolonged 32-second asystole.
• Intravenous atropine was administered for resuscitation.

Findings:

• The patient's syncope was attributed to malignant neurocardiogenic syncope, characterized by significant sinus arrest.
• A dual-chamber rate-responsive pacemaker was successfully implanted the following day.

Implications:

• This case highlights the critical role of electrophysiological evaluation in diagnosing unexplained syncope.
• Permanent pacemaker implantation is a viable strategy for managing malignant neurocardiogenic syncope with prolonged asystole, despite unknown long-term prognosis.
• Early intervention with pacing can effectively prevent recurrent syncope and improve patient outcomes.