Figure 206-11

Asystole in neurocardiogenic syncope. Note the normal heart rate (HR) and blood pressure (BP) in supine position. At the beginning of head-up tilt at 700 (B), some degree of tachycardia is noted. Seven minutes after the onset of tilt (C), an episode of atrioventricutar block occurs and is followed by sinus arrest and a total asystole of 20 s. Syncopal episodes follow. Presyncope is still present when asystole is prevented by atropine (F). Findings in C might tempt one to prescribe permanent pacing, an inappropriate choice of therapy. In this patient with neurocardiogenic syncope, disopyramide (G) prevented hypotension and syncope without the need for a permanent pacemaker. This patient has remained asymptomatic on this therapy for more than 6 years nroo,

(from Sra et al. Reproduced with permission frtim the publisher and authors).