Iatrogenic asystole on the ITU

After he had recovered, he reported that he had suff ered from syncope associated with rapid head movements before his admission; we therefore diagnosed our patient with carotid sinus syndrome (CSS) and he was treated with insertion of a permanent pacemaker. Definitive diagnosis of CSS is important however, because in elderly patients with simple CSH and falls there is evidence that pacemaker implantation does not reduce the risk of falls when compared with implantable loop recorder insertion,4 or when pacing is switched off .5 In the context of documented CSH with profound asystole and associated syncope, permanent pacemaker implantation remains the treatment of first choice.3 In patients who are critically unwell, tachyarrhythmias are common but bradycardia (particularly atrioventricular conduction abnormalities) is usually associated with biochemical abnormalities or cardiac ischaemia; the absence of these features made us suspect that our patient had a pre-existing condition.