Abstract
An injectable loop recorder was implanted in a 76-year old patient due to recurrent unexplained syncope.In the first week after implantation, asymptomatic short-term atrial fibrillation was recorded and oral anticoaguation was prescribed. Two weeks later the patient suffered a presyncope and a 5.8 seconds pause was recorded at the time of conversion of atrial fibrillation to sinus rhythm. A Micra Transcatheter Pacing System was implanted based on the minimum pacing needs. Atrial fibrillation episodes became frequent and severe symptomatic without syncope relapse. Antiarrhythmic treatment was initiated and failed and the patient underwent pulmonary vein isolation 6 months later. Antiarrhythmics were discontinued right after atrial fibrillation ablation.The patient remains free of atrial fibrillation episodes based on the injectable loop recorder 1 year follow up.