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A 66 year old woman with history of phenytoin-controlled seizures and hypothyroidism was admitted after a syncopal attack. Whilst monitored as an inpatient, she suffered another syncopal episode. Telemetry revealed this to be associated with AV dissociation (Figure 1) that lasted for 20 seconds. Thus dual chamber pacemaker was implanted and the patient had no further symptoms at 6 months follow up.
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