Syncope after aortic valve surgery

  • C. CrooijmansEmail author
  • L. M. Rademakers
Open Access
Rhythm Puzzle – Question
A 49-year-old man with a bicuspid aortic valve with severe stenosis and moderately depressed left ventricular ejection fraction underwent implantation of a mechanical aortic prosthesis. During the pre-operative evaluation, the electrocardiogram (ECG) showed sinus rhythm with first-degree atrioventricular block and voltage criteria of left ventricular hypertrophy (Fig. 1).
Fig. 1

ECG during pre-operative evaluation

On the fourth postoperative day, the patient complained of sudden onset of rapid palpitations. The ECG is shown in Fig. 2. Both carotid sinus massage and a rapid intravenous bolus of 20 mg adenosine did neither temporarily slow down nor stop the tachycardia. Meanwhile, his blood pressure had declined to 70/40 mm Hg. A few minutes later, the patient lost consciousness and underwent immediate direct-current (DC) cardioversion. What is your diagnosis?
Fig. 2

ECG during rapid palpitations


You will find the answer elsewhere in this issue.

Copyright information

© The Author(s) 2019

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Authors and Affiliations

  1. 1.Department of CardiologyCatharina ZiekenhuisEindhovenThe Netherlands

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