Syncope with P-AVB was induced by carotid sinus massage. In case 2, the patient had a history of cough syncope. The vagal score (VS) was 5 points: normal baseline ECG, PR prolongation and sinus slowing immediately before P-AVB, initiation of P-AVB by PP prolongation, and sinus slowing during ventricular asystole. Paroxysmal atrioventricular block (P-AVB) was induced during the head-up tilt test. A cardiac pacemaker was implanted in 13 patients.Įpisode in case 1. Abnormal AV conduction was recognized in 4 patients. An electrophysiologic study (EPS) was performed for 11 patients. The index ECG was recorded by ambulatory Holter ECG monitoring for 8 patients, in-hospital ECG monitoring for 6, standard 12-lead ECG for 4, and an implantable loop recorder for 2. The ECG-documented maximum ventricular asystole during P-AVB varied from 3.6 to 60 s. Structural heart disease was observed in 6 patients: coronary artery disease in 4 patients (including 2 patients with a previous myocardial infarction), cardiac tumor involving the left ventricle in 1, and mitral valve prolapse without mitral regurgitation in 1. Baseline 12-lead ECG showed PR prolongation (>0.22 s) in 6 patients, right bundle branch block (RBBB) in 4 including 2 with left axis deviation (LAD), intraventricular conduction disturbance (IVCD) in 1, and no AVB or IVCD in the remaining 10. Their symptoms were syncope in 13 patients (including 1 patient with convulsion during sleep), faintness in 4, and none in 3. The clinical characteristics of the study patients are shown in Table 1. P-AVB was defined as a sudden onset of complete AVB with two or more consecutive blocked P waves and ventricular asystole of >3 s. These patients had clinically documented P-AVB with clear ECG recordings in our institutions. The study population consisted of 20 patients (13 men and seven women), with a mean age of 59.3☑4.7 years (range, 25–78 years).
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