An Asymptomatic Man With an Abnormal ECG

Brenes, Juan C.; Brenes-Pereira, Carlos; Tolentino, Alfonso; Lupu, Cornel

doi:10.1161/circulationaha.117.028373

Cited by 1 publication

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References 2 publications

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“…Atrial dissociation might be incidentally seen on surface ECG without symptoms. 6 , 7 Invasive electrophysiologic study might be needed to identify AD in many cases. 1 , 7 Atrial dissociation may present with AV dissociation when there is electrical isolation between the SA node and the AV node.…”

Section: Discussionmentioning

confidence: 99%

Dual atrial rhythms: a case report of an unusual cause of pacemaker syndrome

Sirinvaravong

Heimann

Liskov

et al. 2022

European Heart Journal - Case Reports

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Background Atrial dissociation (AD) is described as the existence of two simultaneous electrically isolated atrial rhythms. Theoretically, detection of dual atrial rhythms with a sufficiently high rate by pacemaker can lead to automatic mode switching and associated pacemaker syndrome. Such a clinical observation has not been reported before in the literature. Case Summary An 87-year-old female with Ebstein’s anomaly status post tricuspid valve annuloplasty and tricuspid valve replacement and a dual chamber pacemaker presented with congestive heart failure one week after undergoing atrial lead revision. Interrogation of her dual chamber pacemaker revealed two atrial rhythms: sinus or atrial-paced rhythm and electrically isolated atrial tachycardia (AT). Sensing of both atrial rhythms by the pacemaker led to automatic mode switching, which manifested as ventricular paced rhythm with retrograde P waves on electrocardiogram (ECG). Adjusting the atrial lead sensitivity to a level higher than the sensing amplitude of AT restored atrial paced and ventricular sensed rhythm, which resulted in resolution of heart failure symptoms. Discussion Regardless of the cause of AD, there must be electrical insulation between the two rhythms for their independent coexistence in the atria. AD can lead to pacemaker syndrome from automatic mode switching. If the sensing amplitude during sinus rhythm is significantly larger than that of AT, adjusting the atrial lead sensitivity would solve the issue, as in the present case. Otherwise, atrial lead revision, pharmacotherapy or AT ablation should be considered.

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