Psychogenic Syncope? A Cautionary Note http://onlinelibrary.wiley.com/doi/10.1111/j.1540-8159.2009.02400.x/abstract 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. The first and last authors also did an article on POTS in post-Lyme patients that has already been posted: http://www.cardiologyjournal.org/inpress/122010Kanjwal.pdf I'm not sure how respectable they are, but my PC's breaking as I started opening pdf files to look in to it, so thought I'd just post the details up.