Syncope is a concerning symptom that affects a large proportion of patients. It can be related to a heterogeneous group of pathologies ranging from trivial causes to diseases with a high risk of sudden death. However, benign causes are the most frequent, and identifying high-risk patients with potentially severe etiologies is crucial to establish an accurate diagnosis, initiate effective therapy, and alter the prognosis. The term cardiac syncope refers to those episodes where the cause of the cerebral hypoperfusion is directly related to a cardiac disorder, while arrhythmic syncope is cardiac syncope specifically due to rhythm disorders. Indeed, arrhythmias are the most common cause of cardiac syncope. Both bradyarrhythmia and tachyarrhythmia can cause a sudden decrease in cardiac output and produce syncope. In this review, we summarized the main guidelines in the management of patients with syncope of presumed arrhythmic origin. Therefore, we presented a thorough approach to syncope work-up through different tests depending on the clinical characteristics of the patients, risk stratification, and the management of syncope in different scenarios such as structural heart disease and channelopathies.

UNASSIGNED: Arrhythmias are the common, potentially lethal, and treatable complication of acute coronary syndrome (ACS). Arrhythmic findings of ischemic cardiac events are well-known, but long-term results have not been scrutinized. In the study, we aimed to analyze the long-term findings of the atrioventricular block (AVB) in ACS patients.
UNASSIGNED: This is a single-center and retrospective study of patients admitted with ACS and AVB. The primary endpoint has combined the outcome of major adverse cardiovascular events and mortality.
UNASSIGNED: Seventy-six (89.4%) patients had 3rd-degree AVB. Fifty (58.8%) patients are needed for temporary ventricular pacing and 4 (4.7%) for a permanent pacemaker. Although no cardiac death occurred during the 5-year follow-up period, the in-hospital mortality ratio was 30.6%. Patients with older age and lower systolic blood pressure (SBP) levels had higher mortality rates (respectively, odds ratio [OR] 1.088, [p=0.003], OR 0.912, [p<0.001]). Even in ST-segment elevation myocardial infarction and complete AVB subgroup analyses, mortality rates were associated with SBP and age (respectively, OR: 0.917, [p<0.001], OR: 1.107 [p=0.002]), (respectively, OR: 0.917 [p<0.001], OR: 1.087 [p=0.004]).
UNASSIGNED: The study results are associated with a better long-term overall prognosis in patients with ACS with AVB, but lower SBP and older in-hospital follow-up are associated with poor prognosis.

Although Legionnaires\' disease mainly affects the lungs, it can also present with other systemic involvement, including rare cardiac manifestations. Recognised presentations are endocarditis, myocarditis, pericarditis, and pericardial effusion. A 72-year-old British man presented with a six-day history of dry cough and a four-day history of fever during the peak of the COVID-19 pandemic. His electrocardiogram showed Mobitz type II atrio-ventricular block. Although all the cultures were negative, the chest X-ray demonstrated COVID-19 infection-like features. With high clinical suspicions and chest X-ray features, the polymerase chain reaction of the COVID tests was repeated three times and all were negative. He had a positive urinary Legionella antigen, and his bradycardia and heart block improved after treatment with amoxicillin/clavulanic acid, and clarithromycin. As the electrocardiogram showed Mobitz type II, a permanent pacemaker was implanted. The follow-up pacemaker check showed that he still required active pacing.

Device occlusion of perimembranous ventricular septal defect is gaining popularity with the emergence of newer, softer occluders and improved technical know-how. We report a 26-year-old lady with a moderate size perimembranous ventricular septal defect who had a new onset of bundle branch block shortly after device closure. The patient subsequently developed a complete atrio-ventricular heart block.

The appearance of first-degree atrioventricular block and mitral annulus calcification in an end-stage renal failure patient with elevated parathyroid hormone levels should raise the suspicion of metastatic cardiac calcification. Measures should be taken to normalize the parathyroid hormone, calcium, and phosphorus levels to limit the progression of atrioventricular block. Exploration or removal of parathyroid glands should be considered if heart block worsens.

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Complete heart block (CHB) and acute renal infarction (ARI) are both uncommon diseases and seldom encountered in the clinical practice. We describe a rare case of pre-existing left bundle branch block, presenting simultaneously with CHB and ARI. The possible mechanism depends on prior presence of either CHB or ARI. If ARI occurs first, severe pain and embolism may enhance the vagal tone resulting in decrease in the heart rate and transient intraventricular conduction interruption, which subsequently causes CHB. The opposite scenario, CHB preceding ARI, is also possible. CHB can be physiologic and transient, with higher risk of development in the circumstance of pre-existing conduction system disturbances. Patients with CHB are predisposed to formation of thrombi and thromboemboli, giving rise to ARI. In conclusion, awareness and timely identification of the clinical manifestations of these two diseases may facilitate early diagnosis and prompt management.

Delayed complete atrioventricular (AV) block associated with an occluded septal perforator branch (SPB) is an uncommon complication after performing percutaneous coronary intervention (PCI) for the left anterior descending coronary artery (LAD). Here we report the case of a 74-year-old man who underwent elective PCI for proximal LAD complicated with occlusion of the first major SPB and developed a complete AV block 78 hours after PCI was performed. The patient received a temporary transvenous pacemaker via the jugular vein and successfully underwent balloon angioplasty of the lethal \"jailed\" SPB, resulting in recovery from the complete AV block. Permanent pacemaker implantation was avoided. Our findings indicate the importance of postprocedural monitoring and consideration of rescue PCI for an occluded SPB in cases of complicated AV conduction disturbances.

OBJECTIVE: Outcomes after surgical repair of complete atrioventricular septal defect (cAVSD) have improved. With advancing age, the risk of development of dysrhythmias may increase. The aims of this study were to (1) examine development of sinus node dysfunction (SND), atrial and ventricular tachyarrhythmias, and (2) study progression of atrioventricular conduction abnormalities in young adult patients with repaired cAVSD.
METHODS: In this retrospective multicenter study, 74 patients (68% female) with a cAVSD repaired in childhood were included. Patients\' medical files were evaluated for occurrence of SND, atrioventricular conduction block (AVB), atrial and ventricular tachyarrhythmias.
RESULTS: Median age at repair was 6 months (interquartile range 3-10) and median age at last follow-up was 24 years (interquartile range 21-28). SND occurred after a median of 17 years (interquartile range 11-19) after repair in 23% of patients, requiring pacemaker implantation in two patients (12%). Regular supraventricular tachycardia was observed in three patients (4%). Atrial fibrillation and ventricular tachyarrhythmias were not observed. Twenty-seven patients (36%) had first-degree AVB, which was self-limiting in 16 (59%) and persistent in 10 (37%) patients. One patient developed third-degree AVB 7 days after left atrioventricular valve replacement. Spontaneous type II second-degree AVB occurred in a 28-year-old patient. Both patients underwent pacemaker implantation.
CONCLUSIONS: Clinically significant dysrhythmias were uncommon in young adult patients after cAVSD repair. However, three patients required pacemaker implantation for either progression of SND or spontaneous type II second-degree AVB. Longer follow-up should point out whether dysrhythmias will progress or become more prevalent with increasing age.