Case Reports

Arrhythmia Grand Rounds, April 2015, Volume 1, Issue 1: 11-15
DOI: 10.12945/j.agr.2015.00014-14

Syncope Due to Positional Alternating Bundle Branch Block

Shadi Idris, MD, Howard Weitz, MD, FACC, Behzad B. Pavri, MD, FACC

Department of Medicine, Division of Cardiovascular Medicine, Thomas Jefferson University Hospital, Philadelphia, USA


We present the case of a 69-year-old female who described recurrent abrupt syncope associated only with recumbency or leaning forward. She had preexisting LBBB on her ECG, and a structurally normal heart. An implantable loop recorder captured episodes that were flagged as “asystole” and “pause detected,” but analysis of the recordings provided the correct diagnosis, and possible insight into the association with recumbency.

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