Introduction: In some patients with recurrent syncope, the etiology may remain unclear despite extensive evaluation. These patients may sometimes be labeled as having a "psychogenic" cause for their syncope.
Methods: We report on three patients with recurrent unexplained syncope (despite extensive evaluation) who were labeled as having a psychogenic cause for their events. In each patient following placement of an implantable loop recorder, their syncopal events were found to be due to periods of prolonged asystole and/or complete heart block. One patient had prolonged asystole for 44 seconds. In each patient, episodes of syncope were eliminated following permanent pacemaker implantation.
Conclusion: We conclude that physicians should exercise great caution before labeling any patient's syncope as psychogenic and that prolonged monitoring may be necessary to exclude a potential cardiac rhythm-related etiology.