A 79 year old woman with multiple comorbidities was diagnosed with paroxysmal AV Block with the help of carotid sinus massage and prolonged ECG monitoring. She was then treatment with a dual chamber pacemaker.

A 79‐year‐old hypertensive woman presented with recurrent episodes of syncope over a month, increasing in frequency over the last 3 days.

• Echocardiography revealed fair left ventricular contractility, mild aortic stenosis, marked mitral annular calcification, mild mitral stenosis and mild mitral regurgitation.
• Baseline ECG was normal.

• Carotid sinus massage triggered a paroxysmal AV block with slowing of sinus rate, associated with near‐syncope;

• During hospital stay, the patient went intermittently into complete AV block,often with near‐syncope;

• The patient was started on isoprenaline infusion at 2 µg/min, with which the episodes subsided.
• Subsequently, a dual‐chamber pacemaker was implanted, with alleviation of symptoms.

“What is the mechanism of paroxysmal atrioventricular block in a patient with recurrent syncope? – Bansal – 2019 – Journal of Arrhythmia – Wiley Online Library”.