CASE REPORT article
Front. Physiol.
Sec. Cardiac Electrophysiology
Recurrent sinus arrest induced by repeated vomiting
Provisionally accepted
- 1Second Xiangya Hospital, Central South University, Changsha, China
- 2Guilin Hospital of the Second Xiangya Hospital, Guilin, China
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Neuromyelitis optica spectrum disorder (NMOSD) can affect autonomic centers in the dorsal medulla, but presentation with recurrent sinus arrest is extremely rare. We report a 71-year-old woman with 10 days of persistent hiccups and vomiting who developed repeated syncopal episodes. ECG monitoring revealed vomiting-induced bradycardia progressing to sinus arrest, and Holter monitoring showed nocturnal sinus pauses up to 40.6 seconds. Routine cardiac and neurological evaluations were unremarkable, but serum anti–aquaporin-4 antibodies were markedly elevated, and brain MRI demonstrated a dorsal medullary lesion, confirming NMOSD with area postrema involvement. The patient was treated with intravenous immunoglobulin and high-dose methylprednisolone, resulting in complete resolution of vomiting and normalization of sinus node function. A temporary pacemaker was required acutely, and a permanent pacemaker was implanted before discharge. She remained stable on rituximab without relapse. This case underscores that severe vomiting-triggered sinus arrest may be an autonomic manifestation of NMOSD and is reversible with timely immunotherapy.
Keywords: autonomic dysfunction, Neuromyelitis optica spectrum disorder, pacemaker, scope, Sinus arrest
Received: 25 Oct 2025; Accepted: 16 Feb 2026.
Copyright: © 2026 Jiang, Hu, Zhang and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Mingxian Chen
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