Malignant Vasovagal Syncope

UNLABELLED: We report the case of a 21-year-old male whose frequent episodes of loss of consciousness in the dental surgery culminated in the postponement of treatment, pending further investigation. The patient was referred to a cardiologist and submitted to head-up tilt testing, which evoked prolonged asystole, associated with loss of consciousness and mild generalized twitching, confirming a diagnosis of malignant vasovagal syncope. Before dental treatment could be completed, the patient was successfully treated with disopyramide and dual-chamber pacemaker implantation. CLINICAL RELEVANCE: Dentistry can predispose patients to fainting (syncope or vasovagal episode) owing to fear, pain, unusual sights and smells, anxiety, fatigue and fasting, so knowledge of extreme forms of this response are of relevance.