A 14-year-old girl presented with episodes of giddiness and transient loss of consciousness. Her ECG showed a 2:1 atrioventricular block with a heart rate of 45 beats per minute and bizarre T-wave inversions. This is consistent with Stokes-Adams attacks due to intermittent complete heart block. The level of the block needs to be confirmed with HIS bundle electrogram recording but it is likely infranodal given the abnormal QRS morphology. Permanent pacemaker implantation is recommended for recurrent syncopal attacks from complete heart block.

1. DR.SENTHAMIZHSELVAN. K PROF.DR.RAMASAMY’S UNIT ECG OF THE WEEK

3. ecg

7. HIS BUNDLE ELECTROGRAM PA 20-50 msec; AH 50-140 msec HV 35-55 msec;