Blocking out the real diagnosis

PAVB is a poorly-recognised condition that consists of the abrupt occurrence of repetitive block of the atrial impulse, with a relatively long (>2 s) ventricular asystole, leading to potential sudden cardiac death.3 Patients reported with PAVB usually have unambiguous syncopes, but unlike our pat...

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Veröffentlicht in:The Lancet (British edition) 2011-02, Vol.377 (9766), p.690-690
Hauptverfasser: Gambardella, Antonio, Prof, Curcio, Antonio, MD, Labate, Angelo, MD, Mumoli, Laura, MD, Indolfi, Ciro, MD, Quattrone, Aldo, MD
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Sprache:eng
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Zusammenfassung:PAVB is a poorly-recognised condition that consists of the abrupt occurrence of repetitive block of the atrial impulse, with a relatively long (>2 s) ventricular asystole, leading to potential sudden cardiac death.3 Patients reported with PAVB usually have unambiguous syncopes, but unlike our patient, most of them have concomitant cardiac disease or definite triggering factors.3 In our patient, the key clinical features, the spontaneous occurrence of episodes even at night, and the lack of evidence for atrioventricular conduction disease between episodes, were less likely to raise suspicion of cardiac syncope and thus more prone to misdiagnosis. In exceptional cases, asystole can be the consequence of focal epileptic seizures and a likely cause of sudden unexplained death in epilepsy.4 However, unlike PAVB, epileptic asystole always occurs several seconds after the EEG seizure activity.4 Our patient reinforces the difficulty that exists in diagnosing seizure and syncope,5 and emphasises the need to consider cardiac causes in patients with drugresistant epilepsy.5 Contributors All authors were involved with managing the patient and writing the report.
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(10)61496-1