Abstract
The authors report on a patient with ischaemic cardiopathy and chronic congestive heart failure treated with a cardiac resynchronisation therapy device with a defibrillator back-up (CRT-D), who experienced two syncopal episodes. The first syncope was associated with an episode of fast ventricular arrhythmia, correctly recognised and cardioverted by the internal defibrillator. The second episode was independent from arrhythmias but was caused by a transient decrease in cerebral flow, due to a subclavian steal syndrome. This case highlights the importance of differential diagnosis in case of syncopal episodes, even in a clinical context, particularly prone to arrhythmias, such as ischaemic cardiopathy.