Paroxysmal ventricular standstill in 45-year-old man with Stokes-Adams manifestations: case report

Background: Ventricular standstill (VS) is an arrhythmia that is rarely found but can be fatal if it is not properly treated. These arrhythmias occur when supraventricular impulses cannot be raised or there is a barrier to the transmission of impulses from the atria to the ventricles. This case report discusses the symptomatic paroxysmal ventricular standstill in a 45-year-old man with recurrent presyncope complaints and one episode of syncope with seizures.

Case Description: A 45-year-old man came to the PJT Polyclinic at Sanglah General Hospital with complaints that he often experienced sensations like going out (‘mesriut’) since the last 3 years with a duration of between 3-5 seconds. This complaint usually arises when the condition is fatigue and begins with a feeling of heaviness behind the head and then the vision goes dark. When fainting, the patient can still hear the voices of those around him and regains

consciousness after fainting without any weakness / paralysis of the limbs. The patient had control to a neurologist with MRI and EEG results within normal limits. The patient is still actively working in an office to date and no family member has experienced a similar complaint. Physical examination of patients with general well- aware condition, stable hemodynamic conditions and examination of the thorax, abdomen and extremities within normal limits. ECG examination revealed sinus rhythm + early repolarization and AP thorax X-ray within normal limits.

Conclusion: Holter monitor examination for 24 hours was performed on a patient with sinus rhythm accompanied by symptomatic ventricular standstill (syncope episodes with seizures for 9 seconds) and suggested permanent pacemaker (PPM) installation if there is no reversible cause but the patient and family are still negotiating.