Proximal coronary sinus pacing induced prolonged asystole

Atrioventricular node (AVN) is an interatrial septum structure located at the apex of triangle of Koch that modulates the transmission of impulses from atria to the ventricles. Vagally mediated AVN block with high frequency stimulation (HFS) was investigated in a few animal and human studies, but prolonged ventricular asystole that was induced by a low frequency proximal coronary sinus (CS) overdrive pacing has rarely been reported.

A 40-year-old man was admitted in our hospital for evaluation of syncope and palpitation. He presented with prolonged ventricular asystole by proximal CS pacing during electrophysiological study (EPS).

There is no comprehensive clinical study to investigate the association of vasovagal syncope with vagally mediated atrioventricular block (AVB) which is induced by posteroseptal area stimulation. Radiofrequency catheter ablation of ganglionated plexi (GP) located close to sinus node and AVN was reported to eliminate the vagal efferent output during vasovagal syncope as a new treatment strategy.