Paroxysmal atrial fibrillation and intermittent left bundle branch block: an unusual electrocardiographic presentation of mad honey poisoning

Mad honey poisoning occurs through the intake of honey made from the nectar of Rhododendron species containing grayanotoxins, a family of lipid-soluble toxins responsible for the clinical manifestations of mad honey intoxication syndrome. These plants grow in the eastern parts of the Black Sea region of Turkey and in various other parts of the world (e.g., South America, Europe, and Japan). Previous reports concerning mad honey poisoning have generally described various degrees of atrioventricular (AV) block, sinus bradycardia, asystole, nodal rhythm with ventricular parasystole, and even acute myocardial infarction. The diagnosis is often made based on a history of honey intake. We report a unique case of a patient who presented paroxysmal atrial fibrillation and intermittent left bundle branch block related to mad honey poisoning.