Atrial tachycardia without P waves masquerading as an A-V junctional tachycardia.

Abstract

ATRIAL TACHYCARDIA WITHOUT P WAVES/Zipes et al.pathologic anatomy is seemingly so varied, one would expect the physiology to be somewhat varied and that prognosis might be related to a number of factors hitherto unrecognized in these patients.It is our feeling that a number of potential risk factors have been recognized in this study -all requiring long-term follow-up to see which, if any, do indeed increase risk. The abnormalities identified in this study, most of which were totally unsuspected from routine ECG studies and which are suggested as possible risk factors include: 1) nocturnal bradycardia mostly due to junctional exit block, noted in 7/20; 2) tachyarrhythmias (12/20) and especially major tachyarrhythmias (3/20); and 3) unresponsive or "lazy" junctional pacemakers which did not vary discharge rate. Several patients had more than one of these potential risk factors but the only patient with all three suffered a serious syncopal attack. In order to determine whether or not these really are risk factors, we would recommend that follow-up of all patients with congenital heart block should include, in addition to a His study, electromagnetic ECG tape recordings at fairly frequent intervals. The meaning of these described abnormalities is still not sufficiently understood to change recommendations for insertion of permanent pacemakers. These indications, at present, are symptomatic block or evidence of distal block.

Organized Incessant Atrial Arrhythmias in the Setting of Severe, Isolated Biatrial Scarring

“…Zipes et al described two cases of atrial tachycardias without visible P waves that masqueraded as junctional tachycardias 20 . Similar to our cases, these patients had low voltages on intracardiac electrograms and inability to capture the right atria at high outputs.…”