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Atrial standstill (atrial paralysis) is a rare reason for permanent bradycardia. A case of atrial standstill is presented. A 35-year-old man had suffered from bradycardia since his childhood. For 2 years he had complaints (diminishment of his working capacity, and dyspnea occurred with effort) as well. On admission, a slow (38/min) junctional escape rhythm could be detected. There were no signs of atrial mechanical activity (atrial contraction) according to chest x ray, echocardiography, and the atrial pressure curve. The electrophysiological study revealed that the atria could not be electrically stimulated, and no P wave (A wave) could be recorded on right atrial electrograms. The patient received a rate responsive pacemaker. After pacemaker implantation, he became symptom-free; his working capacity improved markedly and his heart size decreased. Owing to the permanent bradycardia and the lack of atrial stimulation, the atrial standstill represents an indication for ventricular rate responsive pacing. Atrial standstill, permanent bradycardia, and the inability to stimulate the atrium are indications for ventricular rate responsive pacing.

The high blood flow rate and the considerable metabolic activity render the myocardium a possible candidate for infrared imaging. The study was aimed to test cardiothermography in evaluating arterial bypass graft patency and in assessing myocardial protection during open-heart surgery. Ten patients underwent arterial bypass grafting. Thermograms were obtained immediately before and after opening the grafts. As the bypasses were opened in hypothermia the warmer blood coming from the extracorporeal circulation readily delineated graft and coronary anatomy. By the end of the 5 mm observation period, the revascularized area exhibited a temperature increase of 5.9±0.7°C. The effectivity of antegrade cardioplegia was monitored in 38 patients undergoing either valve implantations or aorto-coronary bypass surgery. Thermographic images were taken after sternotomy, before aortic cross-clamping and after administering the 4 °C cardioplegic solution. Most of the patients (84%) displayed adequate myocardial cooling, moreover the bypass-group exhibited a more profound temperature-decrease (T10oo: -1 8.7±0.9 °C vs. -17.9±0.8 °C). In conclusion, cardiothermography can visualize arterial grafts, recipient coronaries and collaterals seconds after opening the bypass, thus it properly evaluated arterial bypass graft patency. The obtained images could easily be analyzed for qualitative flow-and quantitative temperature changes. Myocardial protection could also be safely assessed with thermography.

For the sake of developing, regular usage of assist device therapy in Hungary is a prominent task. Development and application of standard protocols providing better quality in organ donor treatment and donation management have to be pressed.

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