Abstract

Background: Syncope in older patients generally reflects underlying cardiovascular pathology, especially conduction system disease. Complete heart block is a reversible yet potentially fatal cause of syncope and requires prompt recognition and pacing. Patients with T2DM and HTN have a higher risk because of progressive conduction tissue fibrosis and ischemia.

Case Presentation: This is the case of a 75-year-old female with known T2DM and HTN presenting with recurrent syncopal episodes. Electrocardiogram showed symptomatic complete heart block. After temporary pacing, she successfully underwent implantation of a St. Jude Medical Endurity PM 1172 MRI-safe VVIR pacemaker via the right subclavian vein. The procedure was uneventful, and she was discharged in a stable condition on optimal medical therapy.

Discussion: Chronic diabetes and hypertension cause structural and electrophysiologic remodeling of the conduction system through microangiopathy, oxidative stress, and interstitial fibrosis, with eventual AV nodal dysfunction. Symptomatic complete AV block necessitates immediate pacing for survival. MRI-compatible pacemakers offer two advantages: first, an effective correction of bradyarrhythmia, and second, preserved accessibility for future neuro- or musculoskeletal imaging. This case illustrates diagnostic vigilance in syncope presenting in elderly diabetic hypertensive patients, temporary pacing stabilization, and the excellent chronic safety profile of MRI-conditional VVIR devices.

Conclusion: This case emphasizes how early diagnosis and prompt implantation of the device are clinically important in elderly diabetic hypertensive patients presenting with symptoms of complete AV block. MRI-conditional VVIR pacemakers ensure both hemodynamic stability and long-term imaging safety, reinforcing their role in contemporary electrophysiologic practice.

DOI: doi.org/10.63721/26JCVI0107

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