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Asystole after Exercise in Healthy Persons

Stefan Osswald, MD; Ross Brooks, MD; Sean S. O'Nunain, MD; Jay H. Curwin, MD; Marc Roelke, MD; Paul Radvany, MD; Jeremy N. Ruskin, MD; and Brian A. McGovern, MD
[+] Article and Author Information

From Massachusetts General Hospital, Boston, Massachusetts; St. Peter's Hospital, Albany, New York. Requests for Reprints: Brian A. McGovern, MD, Cardiac Arrhythmia Service, Massachusetts General Hospital, 32 Fruit Street, Boston, MA 02114. Grant Support: Stefan Osswald is the recipient of a research fellowship granted by the Swiss Lichtenstein Foundation.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1994;120(12):1008-1011. doi:10.7326/0003-4819-120-12-199406150-00007
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Exercise-related syncope is infrequent in healthy persons, although vasodepressor syncope reproduced by positive head-up tilt testing has been reported in small series of healthy persons [1] and athletes [2] with syncope after exercise. Whether vasodepressor syncope may also occur during exercise is controversial and is now an issue of public debate [3]. Asystole after exercise is an extremely rare finding in healthy persons, and single cases without clear proof of the underlying mechanisms have been reported during the past 20 years [47]. We describe three patients with recurrent exercise-related syncope in whom prolonged asystole after exercise was documented. Positive head-up tilt table testing in all three patients suggested neurocardiogenic syncope as the underlying mechanism.

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Figure 1.
The rhythm strip starts 1.

5 minutes after the end of the stress test. After a brief period of progressive sinus bradycardia, sinus arrest occurred for 32.4 seconds with infrequent ventricular escape complexes. Artifacts caused by chest compression are indicated by the white arrows. Chart speed was 25 mm/s.

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