A 79-year-old woman presented to a clinic for a pacemaker follow-up. The patient had a 20-year history of hypertension that was well controlled by her current medication, perindopril (8 mg daily). Ten years ago, the patient had a brief episode of lightheadedness for which she was diagnosed with a transient ischemic attack. When the patient consulted a neurologist for a follow-up, no neurologic deficits were revealed.
However, an MRI scan revealed a small, old lacunar infarct in the basal ganglia that had no correlation with the patient’s symptoms. Furthermore, an ECG revealed a mild left ventricular hypertrophy and a mild left atrial enlargement. Furthermore, the patient reported that 8 years ago, she had similar incidents of a syncopal episode that was diagnosed as paroxysmal high-grade atrioventricular (AV) block. Subsequently, she underwent implantation of a dual-chamber pacemaker…
