Persistent atrial standstill with coronary and cerebral embolism treated with left atrial appendage closure

Sun, Zhonghua; Zhou, Yaoyao; Zhou, Ding; Lam, Yat‐Yin; Yun-zhou, Huang; Zhang, Jian; Chen, Yuanlu; Qi, Xiangqian

doi:10.1016/j.ijcard.2016.09.130

Cited by 2 publications

(2 citation statements)

References 4 publications

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Section: Introductionmentioning

confidence: 99%

“…In spite of progress in the diagnostic work-up of stroke, up to 30% of strokes are called "cryptogenic," which means that no causative factor can be found. We would like to present a case of possible ischemic brain embolism due to mechanical asystole [1] of the atria caused by escape nodal rhythm without retrograde conduction through the AV node.A 78-year-old woman was admitted to the cardiac intensive care unit due to fatigue and dyspnea. The ECG examination revealed escape nodal rhythm of 45 per minute without retrograde conduction and with sporadic (10/min) atrial extrasystoles (Figure1).…”

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confidence: 99%

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Atrial standstill during escape nodal rhythm with no retrograde conduction – a new possible risk factor for ischemic stroke?

Piotrowski¹,

Zaborska²,

Kułakowski³

2017

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Up to 30% of ischemic strokes are called "cryptogenic". We would like to present a case of ischemic brain embolism possibly due to mechanical asystole of the atria caused by escape nodal rhythm without retrograde conduction through the atrioventricular (AV) node. Ischemic stroke is a devastating condition of variable etiology. In spite of progress in the diagnostic work-up of stroke, up to 30% of strokes are called "cryptogenic," which means that no causative factor can be found. We would like to present a case of possible ischemic brain embolism due to mechanical asystole [1] of the atria caused by escape nodal rhythm without retrograde conduction through the AV node.A 78-year-old woman was admitted to the cardiac intensive care unit due to fatigue and dyspnea. The ECG examination revealed escape nodal rhythm of 45 per minute without retrograde conduction and with sporadic (10/min) atrial extrasystoles (Figure1).Blood pressure was 95/50 mmHg. The patient had a history of coronary artery disease, coronary artery bypass graft in the year 2005 and subsequent percutaneous coronary intervention with drug-eluting stent implantation in the left main coronary

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Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

Atrial standstill during escape nodal rhythm with no retrograde conduction – a new possible risk factor for ischemic stroke?

Piotrowski¹,

Zaborska²,

Kułakowski³

2017

Heart Beat

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Nonatrial Fibrillation Patients With Complete P Wave Disappearance

Liu

et al. 2021

Stroke

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Background and Purpose: Complete P wave disappearance (CPWD) in patients without atrial fibrillation is an uncommon clinical phenomenon. We aimed to study the relationship between CPWD and thromboembolism. Methods: Between July 2007 and December 2018, consecutive patients with CPWD on surface ECG and 24-hour Holter recording were recruited into the study from 4 centers in China. All recruited patients underwent transesophageal echocardiography or cardiac computed tomography to screen for atrial thrombus. Atrial electrical activity and scar were assessed by electrophysiological study (EPS) and 3-dimensional electroanatomic mapping. Cardiac structure and function were assessed by multimodality cardiac imaging. Results: Twenty-three consecutive patients (8 male; mean age 48.5±14.7 years) with CPWD were included. Only 3 patients demonstrated complete atrial electrical silence with atrial noncapture. Thirteen patients who had invasive atrial endocardial mapping demonstrated extensive scar. Pulse-wave mitral inflow Doppler demonstrated absent and dampened A waves in 18 and 5 patients, respectively. Pulse-wave tricuspid inflow Doppler showed absent and dampened A waves in 19 and 4 patients, respectively. Upon recruitment, 8 patients had previous stroke and 3 patients had atrial thrombus. Warfarin was prescribed to all patients. During median follow-up of 42.0 months, 2 patients developed massive ischemic stroke due to warfarin discontinuation. Conclusions: Our study suggested that CPWD reflects extensive atrial electrical silence and significantly impaired atrial mechanical function. It was strongly associated with thromboembolism and the clinical triad of CPWD-atrial paralysis-stroke was proposed. Anticoagulation should be recommended in such patients.

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Persistent atrial standstill with coronary and cerebral embolism treated with left atrial appendage closure

Cited by 2 publications

References 4 publications

Atrial standstill during escape nodal rhythm with no retrograde conduction – a new possible risk factor for ischemic stroke?

Atrial standstill during escape nodal rhythm with no retrograde conduction – a new possible risk factor for ischemic stroke?

Nonatrial Fibrillation Patients With Complete P Wave Disappearance

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