Stroke complicating congenital sick sinus syndrome

Lehmann, Ralf; Groenefeld, Gerian; Israel, Carsten W.

doi:10.1007/s00399-007-0564-y

Cited by 2 publications

(1 citation statement)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This form of atrial pathology may increase propensity to thrombus formation, similarly to fibrillating atria, even without conventional CHADS (congestive heart failure, hypertension, age Ն75 years, diabetes mellitus, and prior stroke) risk factors. 20 Atrial fibrillation has been associated with congenital sick sinus syndrome. 2 The presence of atrial inexcitability would appear to be incompatible with (and indeed preclude) the coexistence of fibrillatory effect.…”

Section: E54mentioning

confidence: 99%

Congenital Sick Sinus Syndrome With Atrial Inexcitability and Coronary Sinus Flutter

Varma

Helms

Benson

et al. 2011

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

ongenital sick sinus syndrome has been described sporadically. The syndrome may comprise various components of sinus bradycardia, atrial fibrillation, and right atrial inexcitability. [1][2][3][4][5][6][7] In the current case, detailed electrophysiological evaluation was undertaken with electroanatomic mapping of the right atrium and coronary sinus (CS) and of associated supraventricular arrhythmias. CaseA 37-year-old asymptomatic male physician from Mexico without any previous medical problems was referred after routine physical examination for evaluation of atrial fibrillation with a slow ventricular rate. Arrhythmia duration was unknown. He stated that bradycardia had been consistently noted on previous clinical examinations and had been attributed to competitive long-distance running since childhood. Heart rates in the "40s" had been noted since age 10 to 11 years when he had been informed of a "heart murmur." Subsequent echocardiographic examination had been normal. The patient denied any family history of sudden death or arrhythmias. He had no siblings and no children. His prior records (and those of his parents) were unavailable.Physical examination was normal except for a regular bradycardia of 45 beats/min. Twelve-lead ECG showed fixed R-R intervals. No clear P-wave activity was identified. However, there was small-amplitude baseline electric activity of debatable origin, interpreted variously by experienced electrocardiographers as standstill, artifact, or atrial fibrillation waves ( Figure 1A). A transthoracic echocardiogram showed normal ventricular volume and function (left ventricular end-diastolic diameter, 52 mm; left ventricle end-systolic diameter, 34 mm) and mild tricuspid regurgitation with estimated pulmonary artery systolic pressure of 40 mm Hg. Both atria were severely enlarged (left atrial volume index, 58 mL; right atrial area, 41 cm 2 ). Doppler echocardiographic examination of both tricuspid and mitral atrioventricular (AV) inflow showed complete absence of A waves, indicating lack of left and right atrial contractile activity (Figure 2). A transesophageal echocardiogram did not reveal any evidence of an intracardiac shunt. A Bruce protocol exercise treadmill test was stopped at 10 minutes and 26 s because of patient shortness of breath. Heart rate accelerated gradually to a maximum of 131 beats/min and always remained regular. Baseline atrial activity (if any) was not interpretable because of exercise artifact. Isolated premature ventricular contractions were observed during exercise. A 24-hour Holter monitor showed regular rhythm (mean heart rate, 47 beats/ min; range, 35-95 beats/min; maximum R-R interval, 1.8 s) with 56 ventricular bigeminal cycles. The only symptom during recording periods was an abnormal lateral chest sensation that corresponded with heart rates between 30 and 40 beats/min. The patient underwent an external cardioversion without appreciable change in heart rate (44 beats/min), although electrocardiographic intervals between QRS-T complexes became completely isoel...

show abstract

Section: E54mentioning

confidence: 99%

Congenital Sick Sinus Syndrome With Atrial Inexcitability and Coronary Sinus Flutter

Varma

Helms

Benson

et al. 2011

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

show abstract

Teaching Rounds in Cardiac Electrophysiology

Stevenson

Asirvatham

2010

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

The last 2 decades have seen major advances in clinical electrophysiology, particularly with ablation of complex arrhythmias and the use of implantable devices. Throughout, the main method by which trainees learn continues to be from direct interaction with practicing electrophysiologists. Most of us learned the basic rules for interpreting ECGs and electrograms during "teaching rounds," where specific case-based examples were pointed out and the context and significance of the observation explained. Although training programs are specifically geared to provide this experience, the practicing electrophysiologist can find it a challenge to stay abreast of the plethora of newer mapping, imaging, and ablation techniques, learning their correct application and how to avoid the inevitable pitfalls that can arise.With this issue of the Journal, we are launching "Teaching Rounds in Cardiac Electrophysiology." This series is designed to provide a forum for review and discussion of approaches to diagnosis and therapy, in a teaching rounds format. The series will emphasize fundamentals and classic phenomena while continuously incorporating newer techniques and observations. These articles will be published online, allowing easy access to graphics and video. The series will be edited by Samuel Asirvatham and will begin with a series of articles on cardiac mapping.We are delighted to invite submissions for the series that are consistent with the series objectives. These may include unusual or classic ECG findings, particularly combined with images from new technologies that facilitate the understanding of classic findings or physiology relevant to the practice of clinical electrophysiology. In contrast to "Images in Cardiac Electrophysiology," submissions for the "Teaching Rounds" should include a more extensive discussion to draw from the observations relevant teaching points that have applicability to many other cases. Examples do not have to be images or tracings from a single case but may involve 3 or 4 tracings or images from different cases that are compared with each other to make a teaching point. There will be no charge for publishing color images, and videos are encouraged.We hope that you find "Teaching Rounds in Cardiac Electrophysiology" a valuable and enjoyable addition to your electrophysiology reading.

show abstract

Stroke complicating congenital sick sinus syndrome

Cited by 2 publications

References 22 publications

Congenital Sick Sinus Syndrome With Atrial Inexcitability and Coronary Sinus Flutter

Congenital Sick Sinus Syndrome With Atrial Inexcitability and Coronary Sinus Flutter

Teaching Rounds in Cardiac Electrophysiology

Contact Info

Product

Resources

About