Transient Loss of Consciousness (TLOC) and Tachycardia with Paroxysmal
Atrial Fibrillation
BACKGROUND
A 65-year-old male suffered recurrent syncopal episodes. A review of his
records showed:
- Seven short episodes with loss of consciousness
- History of exertional dyspnea (NYHA II) due to reduced left ventricular function
following myocarditis
- ACE inhibitor use (which improved his exertional dyspnea)
- Ejection fraction of 40%
WORKUP
The patient went through a series of tests including:
- Computer tomography of cerebrum, sonography of carotid arteries, and echocardiogram
all negative
- ECG showed a permanent AV conduction delay of 230 ms with sinus rhythm
- EP examination showed an HV interval extended to 62 ms at 750 ms sinus cycle
length; neither supraventricular nor ventricular arrhythmias could be induced
- Reveal ILR implant
CONCLUSION
Six months after the Reveal implant, the patient experienced another episode and lost
consciousness for approximately 30 seconds. Two recordings were
captured and therapy followed.
- One recording (Figure 1) showed ventricular tachycardia at a rate
of 206 bpm with spontaneous termination

Figure 1: Ventricular Tachycardia
- An additional recording (Figure 2) revealed paroxysmal atrial fibrillation

Figure 2: Paroxysmal Atrial Fibrillation
Source: Lercher P, Brussee H, Rotman B, Klein W,
Clinical Department for Cardiology, Medical University Clinic; Graz, Austria
- Medication-based therapy was initiated with amiodarone
- The patient has had no recurrent events
Data on file. Results may not be typical for every patient.
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