Atrial flutter and post-tachycardia syncope
In this patient, two main hypotheses could initially be evoked to explain the occurrence of sudden syncope: 1) a paroxysmal complete atrioventricular block suggested by the presence of the left bundle branch block; 2) a common ventricular rhythm disorder in patients with ischemic cardiomyopathy. The recorded tracing reveals a third mechanism: a post-tachycardia sinus pause. This type of tracing therefore corresponds to a variant of atrial disease combining atrial fibrillation/flutter episodes and significant pause occurring only at the time of the end of the arrhythmia. This patient underwent a common flutter ablation, a relatively standardized procedure with a success rate exceeding 90%, which eliminated the syncopal episodes.