Syncope in the patient with cardiostimulator

Introduction: Syncopes are episodes of temporary loss of consciousness and muscle tone caused by a sudden and severe reduction in the blood flow to the brain. In patients fitted with cardiostimulators due to an atrioventricular conduct disease, who are dependent on the rhythmic stimulation, pacing malfunctions can lead to the apparition of syncopes with a high risk of sudden cardiac death. Methods: We are presenting the clinical case of a 77 years old patient, with longstanding hypertension and insulin-requiring type 2 diabetes mellitus, presenting to the emergency room due to two episodes of loss of consciousness that occurred within the month (the latter occurred 12 hours before admission) and fatigability. The patient’s medical history shows she is fitted with a permanent electric cardiostimulator for a total atrioventricular block since 2009 and was repeatedly admitted for fractures of the electrode (3 reinterventions). Results: At the time of the medical exam, the patient presents normal values of the blood pressure, without any diff erences in the upper limbs or upon changing from clinostatism to orthostatism, without neurological aff ections or rhythmic, bradycardic heart sounds, and the electrocardiographic aspect shows a total atrioventricular block with a subhisian conduction rhythm, 47/minute, sinus rhythm atriums, 77/minute, spikes without ventricular capture. The data indicate a possible pacing malfunction, which calls for a check-up of the cardiac device by carrying out a sudden increase of the ventricular electrode impedance and a slight increase of the stimulation threshold. Conclusions: The decision was to replace the ventricular electrode with a new implanted one. The measured parameters were as follows: acute threshold 0.4 V to 0.4 ms and an impedance of 836 ohm. The final setting was VVIR 75/min, 3.6 V (0.4 ms) threshold. Conclusion: The pacing malfunction is a challenge that is oft en associated with non-specifi c clinical symptoms, and the electrocardiographic changes can be subtle or even absent at the time of the medical exam due to a variety of causes: progressive fibrosis, myocardial infarction, cardiomyopathies and metabolic disorders. The particularity of our case is the early detection and the immediate repair of the malfunction in a patient with similar episodes that had no apparent cause.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)