On June 15, 2019, about 0415 eastern daylight time, a Piper PA-32-260, N2750Q, impacted trees and terrain while on approach to Crisfield-Somerset County Airport (W41), Crisfield, Maryland. The private pilot sustained minor injuries. The airplane was operated by the pilot as a Title 14 Code of Federal Regulations Part 91 personal flight. Visual meteorological conditions prevailed at the time and no flight plan was filed for the flight that originated about 5 minutes earlier from W41. In statements provided to the Federal Aviation Administration (FAA), Maryland State Police, and also National Transportation Safety Board (NTSB), the pilot reported that he intended to perform one full-stop night landing in advance of a flight planned to depart W41 at 0430. Very light winds favored runway 32 which had an inoperative precision approach path indicator (PAPI). He departed and remained in the airport traffic pattern for runway 32. The crosswind and downwind legs of the airport traffic pattern were uneventful with the airport lights "crystal clear and fully illuminated." Shortly after turning onto the base leg of the airport traffic pattern, the airplane's altitude was between 550 and 600 ft above ground level and he had the airport in sight. He announced turning onto the final leg of the airport traffic pattern for runway 32 and was lined up perfectly with the runway with the airplane landing lights on, and the runway in sight in front of him. While on the final approach of the airport traffic pattern at what appeared to be normal altitude he "last recalled" being 1 mile from the runway 32 threshold and he had 1 flash memory that sometime between his final call and waking up in the crashed airplane, seeing red lights, and "major limbs in the cabin", adding that, "…all [of a] sudden trees came through the cabin (unseen until the impact)." The pilot regained consciousness during daylight, climbed out of the wreckage and walked to his home. The pilot indicated on the submitted NTSB Pilot/Operator Aircraft Accident/Incident Report that to the best of his knowledge there was no preimpact mechanical failure or malfunction. The FAA inspector who examined the wreckage the same day reported the fuselage was resting on its left side in a ditch with the left wing separated and in close proximity among trees, while the right wing remained attached by control cables. The ditch was adjacent to trees at the southern end of an open field, with the accident site located about 1,830 ft southeast of the runway 32 threshold. In an e-mail from the pilot to NTSB on September 12, 2019, he provided information regarding a medical finding that was significant to the investigation. He was asked for and provided the requested medical information. According to the NTSB Medical Factual Report, emergency room records, and post-accident medical records through December 27, 2019 were obtained from the pilot's internist and cardiologist. The emergency room records revealed the complete blood count and metabolic panel were not concerning and no drug panel was ordered. On his first visit to the internist about 1 month after the accident, which appeared to be his routine 6-month follow-up from an earlier exam, the pilot reported the circumstances of the accident and denied falling asleep before the crash, and stated he still had some dizziness since the crash. An electrocardiogram (EKG) at this visit showed a first degree heart block and the internist ordered a cardiac work-up that included a stress echocardiogram and a 24-hour halter monitor for the pilot. On August 15, 2019, the 24-hour halter monitor showed first degree heart block and multiple episodes of complete heart block, notably at least one episode with a 3.5 second pause between heartbeats. For additional information please see the Medical Factual Report contained in the NTSB's public docket for this investigation.