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Brief Report

Recurrent Syncope in a Hypertensive Subject with Vascular Cognitive Impairment and Permanent Pacemaker

by
Alberto Mazza
1,
Roberta Ravenni
2,*,
Domenico Montemurro
3,
Gianni Pastore
4,
Laura Schiavon
1 and
Domenico Rubello
5
1
Department of Internal Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy
2
Department of Neuroscience, Santa Maria della Misericordia Hospital, Rovigo, Italy
3
Department of Internal Medicine, General Hospital of Vicenza
4
Department of Cardiology, Santa Maria della Misericodia Hospital, Rovigo, Italy
5
Department of Nuclear Medicine, Radiology and, Medical Physics, Santa Maria della Misericodia Hospital, Rovigo, Italy
*
Author to whom correspondence should be addressed.
Neurol. Int. 2012, 4(2), e12; https://doi.org/10.4081/ni.2012.e12
Submission received: 13 December 2011 / Revised: 23 July 2012 / Accepted: 30 July 2012 / Published: 4 September 2012

Abstract

Syncope following permanent pacemaker (PM) implantation is a nightmare for electrophysiologists. We describe a case of daily recurrent syncope in an 84-year-old man having a dual-chamber pacemaker implanted for complete atrio-ventricular block occurred 4 years before the admission to our department. He had a history of arterial hypertension, parossistic atrial fibrillation, chronic obstructive pulmonary disease, stage-III chronic renal failure, mild vascular cognitive impairment and glaucoma. The initial work-up including electrocardiogram (ECG), repeated PM inter- rogations, Holter electrocardiogram, blood pressure measurement in orthostatic position, complete blood count, serum glycaemia, electrolytes and thyroid function tests showed normal findings. Syncope occurred in lying position and during 90° left clockwise neck rotation and was associated to pallor, sweating, tonic-clonic seizures and transient self-limited loss of consciousness lasting a few seconds. Electroencephalogram was normal. During continuous ECG monitoring, the right rotation of the head determined a ventricular asystolic pause lasting 9 seconds associated with loss of consciousness. Restoration of sinus rhythm was observed after bringing back the head in axis. The PM interrogation, performed during pacing failure, recorded low impedance of bipolar ventricular lead, suggesting a damage in lead insulation. It is likely that lead movements during clockwise neck rotation produced an intermittent short circuit that prevented sufficient energy delivery to the myocardium with a consequence of sudden loss of capture.
Keywords: synsope; neurology; hypertension; pacemaker synsope; neurology; hypertension; pacemaker

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MDPI and ACS Style

Mazza, A.; Ravenni, R.; Montemurro, D.; Pastore, G.; Schiavon, L.; Rubello, D. Recurrent Syncope in a Hypertensive Subject with Vascular Cognitive Impairment and Permanent Pacemaker. Neurol. Int. 2012, 4, e12. https://doi.org/10.4081/ni.2012.e12

AMA Style

Mazza A, Ravenni R, Montemurro D, Pastore G, Schiavon L, Rubello D. Recurrent Syncope in a Hypertensive Subject with Vascular Cognitive Impairment and Permanent Pacemaker. Neurology International. 2012; 4(2):e12. https://doi.org/10.4081/ni.2012.e12

Chicago/Turabian Style

Mazza, Alberto, Roberta Ravenni, Domenico Montemurro, Gianni Pastore, Laura Schiavon, and Domenico Rubello. 2012. "Recurrent Syncope in a Hypertensive Subject with Vascular Cognitive Impairment and Permanent Pacemaker" Neurology International 4, no. 2: e12. https://doi.org/10.4081/ni.2012.e12

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