Yonsei Med J.  2009 Feb;50(1):156-159. 10.3349/ymj.2009.50.1.156.

Implantable Cardioverter-Defibrillator Implantation in a Patient with Atrial Standstill

• Park SR
• Kwak CH
• Kang YR
• Seo MK
• Kang MK
• Cho JH
• Ahn YJ
• Hwang JY

• KMID: 1782983
• DOI: http://doi.org/10.3349/ymj.2009.50.1.156

Abstract

We report a 55-year-old female patient who presented with no P waves but with a wide QRS complex escape rhythm at 44 beats/min and prolonged QTc of 0.55 seconds on ECG. The patient had recurrence of ventricular fibrillations and loss of consciousness, and underwent defibrillation and cardiopulmonary resuscitation (CPR) several times because of cardiac arrest. The transthoracic echocardiography showed dilated cardiomyopathy and enlargement of both atria. The Doppler echocardiography documented the absence of A wave in the tricuspid and mitral valve flow. An electrophysiologic study demonstrated electrical inactivity in the right and left atria. Atrial pacing with maximum output did not capture the atria. These findings together with her electrocardiographic finding indicated atrial standstill. Sudden cardiac death was her first clinical manifestation of ventricular arrhythmia. The patient remained asymptomatic after receiving a single chamber implantable cardioverter-defibrillator (ICD) with VVI pacemaker function.

Keyword

Atrial standstill; dilated cardiomyopathy; cardiopulmonary resuscitation; sudden cardiac death

MeSH Terms

Bradycardia/*diagnosis/*therapy
Cardiomyopathy, Dilated/*therapy
Death, Sudden, Cardiac
*Defibrillators, Implantable
Electrocardiography
Female
Heart Atria
Humans
Middle Aged
Ventricular Fibrillation/diagnosis/therapy