Cough syncope caused by sinus arrest in a patient with sick sinus syndrome

Cough syncope is a syndrome in which dizziness or syncope occurs after prolonged bouts of cough. This paper presents a case of 63-year-old man with recurrent dizziness and syncope. The 24-hour ambulatory electrocardiogram and intracardiac electrogram showed sinus node dysfunction with sinus arrest, both spontaneous and inducible by voluntary cough. Sinus arrest was sometimes associated with dizziness. A permanent VVI pacemaker was implanted and no further cough syncope has occurred. We suggest that sinus arrest may play a role as a mechanism of cough syncope in a patient with sick sinus syndrome.