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Patient
87-year-old man with ischemic cardiomyopathy and left bundle branch block; hospitalization for repeated syncope; recording of a long tracing (lead II over 1 minute); the patient presented a near-syncope during the recording of the tracing;
Trace
This extended lead II recording allows highlighting a number of elements:
1) initially, there is a probable atrial flutter (sawtooth pattern) with variable conduction and left bundle branch block;
2) the atrial flutter is reduced with the presence of a post-tachycardia sinus pause of 5 seconds;
3) presence of premature atrial extrasystoles with P-on-T pattern;
4) new onset of the atrial arrhythmia;
Exergue
The combination of atrial flutter and post-tachycardia sinus pause is a particular form of atrial disease.
In this patient, two main hypotheses could initially be evoked to explain the occurrence of sudden syncope: 1) a paroxysmal complete atrioventricular block suggested by the presence of the left bundle branch block; 2) a common ventricular rhythm disorder in patients with ischemic cardiomyopathy.