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Challenges in Clinical Electrocardiography |

An Unrecognized, Preventable Cause of Syncope, Malignant Arrhythmia, and Cardiac Death

Janelle Y. Gooden, MD1; Dawn Scantlebury, MBBS2; Samuel Asirvatham, MD2,3
[+] Author Affiliations
1Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
2Division of Cardiovascular Diseases, Mayo Clinic, Rochester
3Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester
JAMA Intern Med. 2013;173(20):1915-1917. doi:10.1001/jamainternmed.2013.7425.
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A 68-year-old-man with a history of hypertension, a previous “silent MI (myocardial infarction),” and prior unexplained syncope experienced a witnessed cardiac arrest. Cardiopulmonary resuscitation was promptly begun by his wife. He was subsequently defibrillated and admitted to the coronary care unit on the cooling protocol. During transportation, episodes of atrial fibrillation (AF) were noted. His electrocardiograms (ECGs) at the time of evaluation of his syncope 10 years before and on admission to hospital are shown in Figure 1.

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Figure 1.
Previous and Presenting Electrocardiograms

Electrocardiograms from 10 years previously (A) and on admission to hospital (B).

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Figure 2.
Clinical Course

A, Narrow complex arrhythmia treated with adenosine. B, Evolving preexcitation tachycardia as a result of adenosine treatment; note alternating wide and narrow complexes. C, Direct current cardioversion.

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