Atrial Standstill with Subnodal Conduction Defect and Diffuse Ventricular Fibrosis Managed with Low Right Atrial Pacing

Abstract

In patients with congenital heart disease presenting with bradyarrhythmia, many electrophysiological abnormalities are found. This report presents a case of a man with surgically corrected single atrium and pulmonary valve stenosis, atrial standstill, delayed AV node conduction, first-degree intra- and second-degree infra-His block, who was permanently paced from a restricted excitable area of the low right atrium, as the pacing threshold was unacceptable at any ventricular site.

Familial Atrial Standstill in Association with Dilated Cardiomyopathy

“…Several points merit consideration in this family. Escape rhythm in atrial standstill is usually narrow complex, 2 and atrioventricular nodal and infra‐nodal conduction disturbances have already been reported 1,3,5,13 . However, both our cases had wide complex escape rhythms and the first case showed alternating right and left bundle branch block, which to the best of our knowledge, has not been previously reported in atrial standstill (Fig.…”

“…1). This finding may reflect more diffuse myocardial and peripheral Purkinje system involvement in the process of the disease 13 . So, we believe that wide complex escape rhythm in atrial standstill should raise the suspicion of concomitant Purkinje system and myocardial involvement.…”