Eagle syndrome presenting with cardiac sinoatrial arrest and recurrent syncope

A man in his mid-40s presented with recurrent episodes of syncope, some of which were triggered by neck extension. In-hospital telemetry documented sinoatrial arrest with a prolonged asystole of 11 s. Computed tomography of the neck demonstrated bilateral elongation of the styloid processes consistent with Eagle syndrome (ES). Vagal reflex stimulation was suspected as the underlying mechanism. A dual-chamber pacemaker was implanted prior to surgical styloidectomy. At 3-month follow-up, pacemaker interrogation revealed 2% pacing activity, with no further syncopal episodes. This case highlights an unusual cardioinhibitory presentation of ES and supports early pacing when surgical resolution of vagal stimulation remains uncertain.