A case of sick sinus syndrome, considered to develop to atrial standstill Hiroshi Nakashima 1 , Motonobu Hayano 1 , Mitsuhiro Tsuruta 1 , Junichi Inoue 1 , Yoichi Imamura 1 , Shuzo Matsuo 1 1Division of Cardiology, The Department of Internal Medicine, Saga Medical School pp.225-229
Published Date 1989/2/15
DOI https://doi.org/10.11477/mf.1404205431
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A 25 year old man was admitted to our hospital because of diziness and bradycardia. Physical exa-mination was normal except for an irregular pulse of 90 beats/min. Chest X-ray film showed no cardio-megaly and no pulmonary congestive changes. ECG showed 2 : 1 or 3 : 1 atrial flutter on admission. After atrial flutter was terminated spontaneously, ECG revealed absent P waves, a QRS interval of 0.10 seconds, and A-V junctional rhythm with irregular R-R interval ranging from 1.20 to 2.12 seconds. At times, cardiac arrest was noted. Esophageal electro-cardiogram also failed to demonstrate atrial activity while A-V junctional rhythm continued. Mitral valve echocardiogram lacked A point, and then a waves were absent in both the right atrial and pul-monary capillary pressure recordings. Transient atrial standstill was suspected from these findings, so that electrophysiological study was performed. Rightatrial electrogram revealed complete absence of atrial activity. His bumdle electrogram revealed H-V prolongation《 80~83 msec.》 Right atrial pacing was attempted at several atrial sites, including the high lateral, middle lateral, low lateral right atrium, and low right atrial septum. Atrial activity could be elicited with stimulus strength of 3 to 5 volts. These atrial pacing thresholds were mild or moderatelyhigher than usual. After the cesation of atrial pacing at 90 beats for two minutes, the recovery time of the first beat prolonged to 8. 46 second. We conside-red that this case was sick sinus syndrome in young adult which revealed generalized disturbance of con-duction system including the atrial muscle, and would develop to atrial standstill in the near future.

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