Anatolian Journal of Emergency Medicine

Yazarlar: Özgecan GÖRMAN, Melis EFEOĞLU SAÇAK, Nurseli BAYRAM, Tunahan ŞEN, Doğuş ÖZYANDI, Yusuf Kenan ÖZKAN, Arzu DENİZBAŞI, Alper KEPEZ

Konular:Tıp

Anahtar Kelimeler:Drowsiness,Presyncope,Sinoatrial pause,Sinoatrial node dysfunction,CARTO ablation

Özet: Aim: Aim of this case presentation is to emphasize on the ECG recording of patients with history of drowsiness or presyncope. Case: 87-year-old male was admitted to the emergency department (ED) with complaints of dizziness, lightheadedness, and drowsiness. He had a history of coronary artery disease and he was being treated as per vertebrobasilar insufficiency because of symptoms. Atrioventricular nodal reentrant tachycardia (AVNRT) and right bundle branch block with bifascicular block was documented in the electrocardiography (ECG) records obtained in our ED. Following the treatment with diltiazem infusion, sinoatrial arrest-pause was captured during the monitorization in the ED. He was handed over to cardiology department for electrophysiologic (EP) study afterwards. Discussion: Sinoatrial (SA) node dysfunction results from any pathology in impulse generation by pacemaker cells in the node or in conduction perinodal transmission cells. The etiologic factors leading to sinus node dysfunction are classified into two pathologies; first is the intrinsic pathology of the SA node, and second group is external causes that affect SA node. The most common intrinsic cause is the agerelated fibrosis of the natural pacemaker cardiac tissue in the SA node. If the pause is longer than 3 seconds, the patient is a candidate for ablation therapy which depends on the result of the non-fluoroscopic electroanatomic mapping (CARTO) ablation technique. Conclusion: Neurological symptoms such as drowsiness and presyncope may often manifest as a result of underlying cardiac pathology. ECG is a very useful tool for these patients if the records are taken at appropriate time.

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