Presyncope in a middle age male

A 54-years male came with history of giddiness on and off along with one episode of blurring of vision since last one day. There was no history of Diabetes mellitus, hypertension or coronary artery diseases.

ECG done in the emergency department is shown below (Click on the image to enlarge it)

ECG is showing sinus bradycardia with heart rate of 50 beats per minute, PR interval was 140 msec, there was right axis deviation with complete right bundle branch block, QTc interval was 386 msec.

So from history and ecg we kept the possibility of Presyncope with Possible Sinus node dysfunction with intraventricular conduction defect. But ECG was not completely diagnostic. So holter was done.

Holter of the patient 

Holter of patient showed bradycardia with average heart rate around 50 beats per minute, there were long sinus pause maximum being of 4 sec during awake time, there was decrease heart rate variability but there was no evidence of any atrioventricular block. So in view of these holter finding patient underwent dual chamber pacemaker and later discharged in stable condition.


Thank you.