[Survived 80 seconds of asystole without damage! : Consequences for better Holter diagnostics]

A 67-year old women suffered multiple syncope episodes during a vacation trip. The emergency 12-lead electrocardiogram revealed a sinusrhythm, AV block I° and left bundle branch block. After admission to the base hospital, a Holter ECG system was implemented. The next morning, the woman collapsed unnoticed. By chance, she was found and stabilized by nurses. The Holter report showed a total AV block over 80 seconds without ventricular replacement rhythm. The patient recovered without neurological damage and got a pacemacer system (DDDR). To the best of our knowledge, this is the longest documented total AV block survived without clinical damage.Conclusion: 1. The emergency 12-lead electrocardiogram (Index ECG) has prognostic power. 2. It is absolutely necessary to integrate alert functions in Holter ECG systems to enable external help in case of threatening arrhythmias.