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Persistent dizziness
  1. R Sivakumar,
  2. P Ghosh,
  3. S A Khan
  1. Department of Care of Elderly, Lister Hospital, Stevenage, Herts SG1 4AB, UK
  1. Correspondence to:
 Dr Sivakumar;
 sivasiva51{at}hotmail.com

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Answers on p 692

An 80 year old woman was investigated for palpitations, dizziness, and episodes of syncope. The electrocardiogram (ECG) showed atrial fibrillation. Twenty four hour Holter recording revealed atrial fibrillation throughout with intermittent pauses of more than 6 seconds. A ventricle (paced) ventricle (sensed) inhibitory and rate responsive (VVIR) pacemaker was inserted. However the patient continued to be symptomatic with episodes of dizziness and presyncope. Her ECG (see fig 1) is shown and the subsequent 24 hour tape revealed similar findings.

QUESTIONS

  1. What are the two significant electrocardiographic findings in this clinical context?

  2. What is the diagnosis?

  3. What is the definitive treatment?

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