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Background: Micturition syncope is an, in adults, uncommon type of reflex syncope, often thought to be benign; however in combination with an extreme cardioinhibitory response it could lead to a full cardiac arrest.
Case Summary: A 42-year old man was admitted to the cardiac ward for rhythm monitoring after being presented at the emergency room due to a syncope during urination with traumatic spinal fractures as result. During cardiac surveillance patient had the urge for urination and during micturition, while sitting on the edge of the bed, suddenly collapsed. Rhythm monitoring showed an asystole of over 40 seconds requiring cardiopulmonary resuscitation. After resuscitation patient regained consciousness without any neurological deficits. Due to the observed prevailing cardioinhibitory response leading to asystole and syncope during micturition it was decided to implant a dual chamber pacemaker with rate-drop response. Patient experienced no recurrent syncopal episode afterwards.
Discussion: This is the first case of a micturition syncope with an extreme cardioinhibitory response requiring cardiopulmonary resuscitation and pacemaker implantation in an adult. When evaluating patients with suspected recurrent reflex syncope caution should be taken into classifying the syndrome as purely benign, and patients should be analysed appropriately.

Keywords: Syncope; Micturition syncope; Cardiopulmonary resuscitation; Cardiac pacing; Case report