Asystolie in überraschendem Zusammenhang

Asystole in a surprising context: A previously healthy 37-year-old patient was admitted to our hospital for evaluation of syncope. Continuous ECG monitoring revealed repeated asystoles with a duration of up to 25 seconds. In the absence of echocardiographic abnormalities or evidence of a reversible cause of sinus node dysfunction, a dual-chamber pacemaker was implanted. In the following few days the patient developed fever, low grade headache, emesis and marked disorientation. Viral encephalitis was diagnosed by demonstration of lymphocytic pleiocytosis and herpes simplex virus type1 by PCR in the cerebrospinal fluid. An association between herpes simplex encephalitis and bradyarrhythmias has been described previously. We review the literature supporting a possible pathogenetic link. The arrhythmias are known to be of a transient nature and permanent pacing is not usually necessary.