The Longer the Block, the Harder You Fall: Extrinsic Idiopathic Atrioventricular Block Masquerading as Seizures

Naima Maqsood; David B Laslett; Aadhar Patil; Anuj Basil; Michael P Gannon; Isaac R Whitman

doi:10.1016/j.jaccas.2021.04.011

The Longer the Block, the Harder You Fall: Extrinsic Idiopathic Atrioventricular Block Masquerading as Seizures

JACC Case Rep. 2021 Jun 9;3(8):1086-1090. doi: 10.1016/j.jaccas.2021.04.011. eCollection 2021 Jul 21.

Authors

Naima Maqsood¹, David B Laslett², Aadhar Patil³, Anuj Basil², Michael P Gannon³, Isaac R Whitman²

Affiliations

¹ Department of Medicine, Lewis Katz School of Medicine at the Temple University Hospital, Philadelphia, Pennsylvania, USA.
² Section of Cardiac Electrophysiology, Lewis Katz School of Medicine at the Temple University Hospital, Philadelphia, Pennsylvania, USA.
³ Temple Heart and Vascular Institute, Lewis Katz School of Medicine at the Temple University Hospital, Philadelphia, Pennsylvania, USA.

Abstract

History and physical examination are the diagnostic cornerstones of transient loss of consciousness (TLOC). However, details can be scarce and examination unrevealing, thus making the diagnosis elusive. In a case of convulsive TLOC, the initial diagnosis was incorrect, but a fortuitously captured event on telemetry yielded the diagnosis: extrinsic idiopathic atrioventricular block. (Level of Difficulty: Beginner.).

Keywords: AAI, single-chamber atrial pacing mode; APL, plasma adenosine level; AV, atrioventricular; AVB, atrioventricular block; DDD, dual-chamber pacing mode; ECG, electrocardiogram; EI-AVB, extrinsic idiopathic atrioventricular block; ENT1, equilibrative nucleoside transporter 1; EV-AVB, extrinsic vagal atrioventricular block; I-AVB, intrinsic atrioventricular block; MVP, Managed Ventricular Pacing; PNES, psychogenic nonepileptic seizures; TLOC, transient loss of consciousness; convulsive syncope; extrinsic idiopathic atrioventricular block; paroxysmal atrioventricular block; plasma adenosine levels; transient loss of consciousness.

Publication types

Case Reports