Paroxysmal Ventricular Standstill—A Case Report of all Ps and no QRS in Ventricular Asystole

Paroxysmal ventricular standstill, also known as ventricular asystole, is a very rare, often fatal arrhythmia that should be included in the differential of patients presenting with syncope. 1 In this case, a 68-year-old female presented to the emergency department (ED) after sustaining a syncopal episode and subsequent cardiac arrest. On review of cardiac telemetry, she was found to be having episodes of ventricular standstill (VS). Due to her altered mental status, transcutaneous and then transvenous cardiac pacing were initiated. The patient was taken to the catheterization lab where she was found to have no significant coronary blockage, and a permanent pacemaker was placed. The likely culprit was calcium channel blocker toxicity. Paroxysmal ventricular standstill is a non-perfusable arrhythmia that should be rapidly identified. While VS is often a fatal arrhythmia presenting with sudden death, reversible causes should be pursued and treated.2 TOPICS: Ventricular standstill, ventricular asystole, heart block, cardiac arrest, emergency pacemaker, transcutaneous pacemaker, transvenous pacemaker, cardiology, Visual EM.