Asymptomatic asystole in a child with cardioinhibitory syncope
It is frequently difficult to establish the pathogenetic mechanism of faints in patients with sinus node dysfunction due to the similar clinical manifestations of cardioinhibitory reflex syncope and Morgagni-Adams-Stokes syncopal episodes; to the intermittent course of sick sinus syndrome; to no correlation between the clinical manifestations and duration of asystole at the moment of the episode. The described clinical case demonstrates a diagnostic search for the mechanism of syncopal states running with asystole in a teenager with sinus node dysfunction. A long-term (48-month) follow-up in a female patient repeatedly documented asystoles during provoked syncopal and presyncopal states, which could ascertain the reflex genesis of syncope (its cardioinhibitory type with asystole). A 12400-ms asystole episode recorded with ECG loop recorders (REVEAL) was single, accompanied by no clinical manifestations and therefore it had no impact on further treatment policy.