Sun Yanxiang, Feng Li, Huang Xuansheng, Hu Bing, Yuan Yong
Department of Cardiology, Zhongshan City People's Hospital, Zhongshan, China.
Front Cardiovasc Med. 2023 Mar 8;10:1117244. doi: 10.3389/fcvm.2023.1117244. eCollection 2023.
Syncope caused by atrioventricular block may occur as a result of a cardiac vasodepressor reflex. This article reports on a case of recurrent syncope in an 80-year-old woman with high-grade atrioventricular block, documented by electrocardiographic monitoring after pacemaker implantation. Pacemaker testing revealed stable impedance and sensing but a clear increase in the ventricular capture threshold at outputs. This case is unusual because the patient's primary diagnosis was non-cardiac. However, a combination of high D-dimer, hypoxemia, and computerized tomography scan of the pulmonary artery confirmed the diagnosis of pulmonary embolism (PE). With 1 month of anticoagulant therapy, the ventricular capture threshold gradually dropped to the normal range and syncope resolved. This is the first report of an electrophysiological phenomenon detected by pacemaker testing in a patient with syncope arising from PE.
房室传导阻滞引起的晕厥可能是心脏血管减压反射的结果。本文报道了一例80岁女性反复晕厥的病例，该患者患有高度房室传导阻滞，在植入起搏器后通过心电图监测得以记录。起搏器测试显示阻抗和感知稳定，但输出时心室捕获阈值明显升高。该病例不同寻常，因为患者的初步诊断为非心脏疾病。然而，高D-二聚体、低氧血症以及肺动脉计算机断层扫描结果相结合，确诊为肺栓塞（PE）。经过1个月的抗凝治疗，心室捕获阈值逐渐降至正常范围，晕厥症状得以缓解。这是首例关于起搏器测试检测到电生理现象的报告，该现象出现在因PE导致晕厥的患者中。
