CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 4, July/August 2011
212
AFRICA
Images in Cardiology
Malignant convulsive vasovagal syncope
B AMASYALI
Abstract
A patient was referred for evaluation of repeated episodes of
syncope with loss of consciousness and convulsions. A dual-
chamber pacemaker with rate-drop feature was implanted.
Keyword:
syncope
Submitted 25/10/10, accepted 1/11/10
Cardiovasc J Afr
2011;
22
: 212
DOI: 10.5830/CVJA–2010–089
A 37-year-old man was referred for evaluation of repeated
episodes of syncope. The episodes had always occurred in the
upright position, without any prodromal symptoms. Although
he had had a history of hyperthyroidism for six months, he was
euthyroid during evaluation for the syncope. His laboratory tests
were within normal limits. Cardiological examination, echocar-
diography and 24-hour Holter monitoring were normal.
A tilt table test was obtained as part of the syncope evalua-
tion. He had an asystolic pause at the 20th minute of the test.
The asystolic pause continued despite the administration of 1 mg intravenous atropine sulphate at the 10th second. It lasted
24.340 seconds until the first junctional escape beat and 38.460
seconds until the first conducted sinus beat (Fig. 1), with loss of
consciousness and convulsions.
On the basis of these results, a dual-chamber pacemaker with
rate-drop feature was implanted. At nine months of follow-up,
the patient reported no more episodes of syncope.
Gulhane Military Medical Academy, Department of
Cardiology, Ankara, Turkey
B AMASYALI, MD,
Fig. 1. The rhythm strip during tilt-table testing, showing
the malignant asystolic pause. Asterisk: first junctional
escape beat; arrow: first conducted sinus beat.
