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.
Text Size: A A A
Published online


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.

Figures in this Article


Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption
Figure 1.
Previous and Presenting Electrocardiograms

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

Graphic Jump Location
Place holder to copy figure label and caption
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.

Graphic Jump Location




Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Related Topics