[A patient with second-degree AV block-further work-up and treatment].

We present the case of a 64-year-old man who presented to our outpatient clinic with intermittent palpitations and presyncopal events. In 2009, he underwent dual chamber pacemaker implantation in another institution for 2nd degree heart block. Pharmacological treatment attempts with β‑blocker, calcium channel antagonists and ivabradine remained clinically unsuccessful. Up to this point in time, no documentation of clinical tachycardia, which was reported to result in a heart rate of around 160 beats/minute, was obtained. The patient presented to our clinic for further electrophysiological evaluation.