SPONTANEOUSLY TERMINATING VENTRICULAR-FIBRILLATION AND ASYSTOLE INDUCED BY SILENT ISCHEMIA CAUSING RECURRENT SYNCOPE

A 57 year old man was admitted for investigation of recurrent syncopal attacks. Holter monitoring during an attack while in hospital reveale d a unique sequence of gross ST segment elevation, ventricular tachyca rdia, prolonged ventricular fibrillation, asystole, junctional and ven tricular escape rhythm, and finally spontaneous restoration of sinus r hythm with severe ST segment depression. Subsequent coronary arteriogr aphy demonstrated severe stenoses of the right coronary artery, prompt ing percutaneous transluminal angioplasty and stenting. The patient ha s had no further syncopal attacks.