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Palpitations and dizziness in a 64-year-old man
  1. Yasbanoo Moayedi1,
  2. Ramanan Kumareswaran1,2,
  3. Paul Angaran1,2
  1. 1 Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Canada
  2. 2 Division of Cardiology, St. Michael's Hospital, Toronto, Canada
  1. Correspondence to Dr Paul Angaran, St. Michael's Hospital, 30 Bond Street, Suite 6-050, Donnelly Wing, Toronto, Ontario, Canada M5B 1W8; angaranp{at}smh.ca

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CLINICAL INTRODUCTION

A 64-year-old man with a previous history of paroxysmal atrial fibrillation presented with symptoms of periodic palpitations, vertigo and dizziness. He had not experienced frank syncope but felt fatigue and weakness with exertion. His medications included bisoprolol and amiodarone. A 48-h Holter and 2-week loop recorder had not shown symptom–rhythm correlation. His ECG showed sinus bradycardia at 57 bpm with a normal PR interval and left bundle branch block. Transthoracic echocardiogram revealed normal left ventricular size, a low normal EF 50%–55% and a mildly dilated left atrium. The patient agreed to undergo a left pectoral subcutaneous implantable loop recorder (ILR) for further assessment of a suspected arrhythmia.

The patient continued to have symptoms. There are multiple device-triggered episodes labelled …

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