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Figure 12.
Brugada syndrome.
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Syncopal atrial fibrillation (AF) is rare, unless there is severe underlying structural Necrostatin 1 disease, sinus node disease producing long pauses when the AF stops, or if the ventricular response to AF is very fast (>250/min – usually caused by pre-excitation in Wolff–Parkinson–White syndrome).
Bradyarrhythmias resulting in syncope include:
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sinus node disease (often diagnosed from low heart rate variability on 24-h ECG)
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high-grade AV block.
In patients who are not in heart block (Figure 13) on arrival in hospital, the clue that intermittent heart block underlies syncope is usually the finding of extensive conducting tissue disease on inter-attack 12-lead ECG (Figure 14).
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Look for evidence of damage to the atrioventricular conduction system, which is apparent on the ECG as a long PR interval
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Look for damage to the specialized conducting system of the ventricle, which is seen as right or left bundle branch block.
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