Prolonged asystole during head-up tilt testing in a patient with Behcet’s disease

Behcet’s disease (BD) is a systemic inflammatory disorder and cardiac involvement is rare. Head-up tilt test is used for evaluating patients with neurocardiogenic syncope (NCS) and syncope of unknown etiology. A 31-year-old woman was examined for three syncopal episodes during the past two months, all of which preceded by nausea and sweating. Examinations including electrocardiography and echocardiography showed normal findings. A head-up tilt table testing was performed at an angle of 60 degrees. At about 8 minutes, syncope associated with bradycardia and asystole was observed. She became hypotensive, and there was a ventricular asystolic pause lasting 20 seconds, associated with loss of consciousness. She was placed in the supine position and cardiac massage was started. After 20 seconds, she slowly returned to sinus rhythm and regained consciousness. The patient was treated with dual-chamber (DDD-R) pacemaker implantation. During six months of follow-up, no major events occurred.