Nietypowe objawy po masażu zatoki szyjnej u chorej z blokiem przedniej wiązki lewej odnogi — opis przypadku

A 65-year-old diabetic and hypertensive woman was admitted for evaluation of syncope. Her baseline electrocardiogram revealed normal sinus rhythm with left anterior hemiblock. Her treadmill test, holter monitoring and external loop recorder examinations were normal. Right sided carotid sinus massage (CSM) revealed 2:1 atrioventricular block (AV) (Mobitz II type) while left sided CSM had no effect. Permanent pacemaker implantation was performed (DDIR, St Jude Medical, USA). Mobitz II type AV block due to CSM reflects enhanced vagal efferent tone on AV node and his bundle fibre.