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Annals of Noninvasive Electrocardiology... Mar 2017Atrial standstill is a rare disorder of cardiac rhythm that is characterized by total absence of electrical activity in one or both atria. We report herein the case of a...
Atrial standstill is a rare disorder of cardiac rhythm that is characterized by total absence of electrical activity in one or both atria. We report herein the case of a patient with atrial fibrillation and symptomatic 4.0 s pauses who received a ventricular demand pacemaker. The patient later underwent mitral valve replacement with a pericardial tissue valve and the Cox-maze III procedure for symptomatic mitral stenosis and atrial fibrillation. Following surgery, he developed atrial standstill and became pacemaker dependent. The pacemaker was later revised to an atrioventricular sequential pacemaker. Twelve hours after revision, atrioventricular sequential pacing was noted and mechanical function of the atria was confirmed by Doppler echocardiography.
Topics: Atrial Fibrillation; Cardiomyopathies; Echocardiography, Doppler; Electrocardiography; Genetic Diseases, Inborn; Heart Atria; Heart Block; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Mitral Valve Stenosis; Pacemaker, Artificial; Postoperative Complications
PubMed: 27558131
DOI: 10.1111/anec.12399 -
Journal of Cardiology Cases Nov 2016Most of the abnormal cardiac conduction system findings are atrial tachyarrhythmias in cardiac sarcoidosis. However, atrial standstill as a sick-sinus syndrome could be...
Most of the abnormal cardiac conduction system findings are atrial tachyarrhythmias in cardiac sarcoidosis. However, atrial standstill as a sick-sinus syndrome could be complicated in the case of diffuse atrial fibrosis. Herein, we present an interesting and valuable case of atrial standstill with suspected isolated cardiac sarcoidosis. < The chronic inflammation caused by isolated cardiac sarcoidosis could impair the conduction system. With atrial standstill, we recommend a comprehensive effort to investigate the potential etiology including cardiac sarcoidosis, particularly in the case of enlarged atrium and ventricular dysfunction.>.
PubMed: 30546677
DOI: 10.1016/j.jccase.2016.06.010 -
Circulation Journal : Official Journal... Jul 2016Atrial standstill is one of the important clinical consequences on the heart in severe hyperkalemia, but it occurs even at modest potassium ion elevation. The extent to... (Clinical Trial)
Clinical Trial
BACKGROUND
Atrial standstill is one of the important clinical consequences on the heart in severe hyperkalemia, but it occurs even at modest potassium ion elevation. The extent to which other factors might potentiate the electrocardiographic changes induced by hyperkalemia remains unclear.
METHODS AND RESULTS
This was a retrospective review of the data on 12,639 hospital admissions over a 15-year period. A total of 778 patients with hyperkalemia were identified, 28 of whom had atrial standstill, and had several parameters measured prior to any treatment of hyperkalemia. Patients with atrial standstill were older (P=0.036), had lower diastolic blood pressure (DBP; P<0.0001) and serum sodium concentration (P<0.0001), higher serum potassium (P<0.0001), and high prevalence of angiotensin converting-enzyme inhibitor (ACEI; P=0.009) or mineral corticoid receptor (MR)-blocker (P=0.006), compared with those without atrial standstill. On multivariate logistic regression, DBP <67 mmHg (P=0.006), serum sodium ion <135 mmol/L (P=0.006) and serum potassium ion >6.1 mmol/L (P=0.018) were identified as independent indicators of atrial standstill, after adjusting for sex, age, chronic maintenance hemodialysis, diuretics use or ACEI/angiotensin receptor blocker and MR blocker.
CONCLUSIONS
Hyponatremia and decline in DBP are associated with atrial standstill in patients with hyperkalemia. (Circ J 2016; 80: 1781-1786).
Topics: Aged; Aged, 80 and over; Arrhythmias, Cardiac; Blood Pressure; Female; Humans; Hyperkalemia; Hyponatremia; Male; Middle Aged; Retrospective Studies
PubMed: 27301330
DOI: 10.1253/circj.CJ-16-0283 -
Circulation May 2016Although sinus node dysfunction (SND) and atrial arrhythmias frequently coexist and interact, the putative mechanism linking the 2 remain unclear. Although SND is... (Review)
Review
Although sinus node dysfunction (SND) and atrial arrhythmias frequently coexist and interact, the putative mechanism linking the 2 remain unclear. Although SND is accompanied by atrial myocardial structural changes in the right atrium, atrial fibrillation (AF) is a disease of variable interactions between left atrial triggers and substrate most commonly of left atrial origin. Significant advances have been made in our understanding of the genetic and pathophysiologic mechanism underlying the development and progression of SND and AF. Although some patients manifest SND as a result of electric remodeling induced by periods of AF, others develop progressive atrial structural remodeling that gives rise to both conditions together. The treatment strategy will thus vary according to the predominant disease phenotype. Although catheter ablation will benefit patients with predominantly AF and secondary SND, cardiac pacing may be the mainstay of therapy for patients with predominant fibrotic atrial cardiomyopathy. This contemporary review summarizes current knowledge on sinus node pathophysiology with the broader goal of yielding insights into the complex relationship between sinus node disease and atrial arrhythmias.
Topics: Adrenergic beta-Antagonists; Animals; Atrial Fibrillation; Brugada Syndrome; Cardiac Conduction System Disease; Cardiac Pacing, Artificial; Humans; Sick Sinus Syndrome; Sinoatrial Node
PubMed: 27166347
DOI: 10.1161/CIRCULATIONAHA.116.018011 -
Circulation Jun 2016The arrhythmogenesis of ventricular myocardial ischemia has been extensively studied, but models of atrial ischemia in humans are lacking. This study aimed at describing...
BACKGROUND
The arrhythmogenesis of ventricular myocardial ischemia has been extensively studied, but models of atrial ischemia in humans are lacking. This study aimed at describing the electrophysiological alterations induced by acute atrial ischemia secondary to atrial coronary branch occlusion during elective coronary angioplasty.
METHODS AND RESULTS
Clinical data, 12-lead ECG, 12-hour Holter recordings, coronary angiography, and serial plasma levels of high-sensitivity troponin T and midregional proatrial natriuretic peptide were prospectively analyzed in 109 patients undergoing elective angioplasty of right or circumflex coronary arteries. Atrial coronary branches were identified and after the procedure patients were allocated into two groups: atrial branch occlusion (ABO, n=17) and atrial branch patency (non-ABO, n=92). In comparison with the non-ABO, patients with ABO showed: (1) higher incidence of periprocedural myocardial infarction (20% versus 53%, P=0.01); (2) more frequent intra-atrial conduction delay (19% versus 46%, P=0.03); (3) more marked PR segment deviation in the Holter recordings; and (4) higher incidence of atrial tachycardia (15% versus 41%, P=0.02) and atrial fibrillation (0% versus 12%, P=0.03). After adjustment by a propensity score, ABO was an independent predictor of periprocedural infarction (odds ratio, 3.4; 95% confidence interval, 1.01-11.6, P<0.05) and atrial arrhythmias (odds ratio, 5.1; 95% confidence interval, 1.2-20.5, P=0.02).
CONCLUSIONS
Selective atrial coronary artery occlusion during elective percutaneous transluminal coronary angioplasty is associated with myocardial ischemic damage, atrial arrhythmias, and intra-atrial conduction delay. Our data suggest that atrial ischemic episodes might be considered as a potential cause of atrial fibrillation in patients with chronic coronary artery disease.
Topics: Action Potentials; Aged; Angioplasty, Balloon, Coronary; Arrhythmias, Cardiac; Atrial Natriuretic Factor; Biomarkers; Chi-Square Distribution; Constriction, Pathologic; Coronary Angiography; Coronary Circulation; Coronary Occlusion; Coronary Vessels; Electrocardiography, Ambulatory; Female; Heart Atria; Heart Conduction System; Heart Rate; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; Myocardial Infarction; Odds Ratio; Propensity Score; Prospective Studies; Risk Factors; Time Factors; Troponin T
PubMed: 27151531
DOI: 10.1161/CIRCULATIONAHA.116.021700 -
The American Journal of Emergency... May 2016
Topics: Atrial Fibrillation; Cardiomyopathies; Electrocardiography; Heart Arrest; Heart Atria; Heart Block; Humans
PubMed: 26976773
DOI: 10.1016/j.ajem.2016.02.071 -
The Canadian Veterinary Journal = La... Mar 2016Pacemakers were implanted in 4 client-owned female dogs which had persistent atrial standstill. Three dogs were alive after 14 to 39 months and 1 dog was euthanized...
Pacemakers were implanted in 4 client-owned female dogs which had persistent atrial standstill. Three dogs were alive after 14 to 39 months and 1 dog was euthanized after 10.5 years. This report demonstrates that some dogs with persistent atrial standstill can survive for extended time periods.
Topics: Animals; Cardiomyopathies; Dog Diseases; Dogs; Female; Genetic Diseases, Inborn; Heart Atria; Heart Block; Pacemaker, Artificial; Survival Rate; Treatment Outcome
PubMed: 26933268
DOI: No ID Found -
Journal of Veterinary Cardiology : the... Jun 2016Two young Labrador retriever dogs with bradycardia-induced syncope resulting from atrial myopathy underwent permanent transvenous pacemaker implantation. Both dogs...
Two young Labrador retriever dogs with bradycardia-induced syncope resulting from atrial myopathy underwent permanent transvenous pacemaker implantation. Both dogs developed heart failure 3-5 years after pacemaker implantation. Both were managed medically for approximately 7 years after pacemaker implantation and, ultimately, were humanely euthanized due to refractory heart failure signs and quality of life concerns. Long-term management of dogs with atrial myopathy and secondary atrial standstill with pacemaker implantation and medical therapy for heart failure is feasible and prognosis may be better than previously reported or speculated.
Topics: Animals; Cardiomyopathies; Dog Diseases; Dogs; Female; Genetic Diseases, Inborn; Heart Atria; Heart Block; Heart Failure; Male; Pacemaker, Artificial; Prognosis; Syncope
PubMed: 26923757
DOI: 10.1016/j.jvc.2015.11.003 -
Biochimica Et Biophysica Acta Jul 2016The SCN5A gene encodes the alpha-subunit of the Nav1.5 ion channel protein, which is responsible for the sodium inward current (INa). Since 1995 several hundred... (Review)
Review
The SCN5A gene encodes the alpha-subunit of the Nav1.5 ion channel protein, which is responsible for the sodium inward current (INa). Since 1995 several hundred mutations in this gene have been found to be causative for inherited arrhythmias including Long QT syndrome, Brugada syndrome, cardiac conduction disease, sudden infant death syndrome, etc. As expected these syndromes are primarily electrical heart diseases leading to life-threatening arrhythmias with an "apparently normal heart". In 2003 a new form of dilated cardiomyopathy was identified associated with mutations in the SCN5A gene. Recently mutations have been also found in patients with arrhythmogenic right ventricular cardiomyopathy and atrial standstill. The purpose of this review is to outline and analyze the following four topics: 1) SCN5A genetic variants linked to different cardiomyopathies; 2) clinical manifestations of the known mutations; 3) possible molecular mechanisms of myocardial remodeling; and 4) the potential implications of gene-specific treatment for those disorders. This article is part of a Special Issue entitled: Cardiomyocyte Biology: Integration of Developmental and Environmental Cues in the Heart edited by Marcus Schaub and Hughes Abriel.
Topics: Action Potentials; Animals; Cardiomyopathies; Genetic Markers; Genetic Predisposition to Disease; Genetic Therapy; Heart Rate; Humans; Mutation; Myocytes, Cardiac; NAV1.5 Voltage-Gated Sodium Channel; Phenotype; Risk Factors; Ventricular Remodeling
PubMed: 26916278
DOI: 10.1016/j.bbamcr.2016.02.014 -
Indian Pediatrics Feb 2016Atrial standstill manifests as absence of any atrial electrical activity in the surface ECG leads. Persistent atrial standstill secondary to acute myocarditis is...
BACKGROUND
Atrial standstill manifests as absence of any atrial electrical activity in the surface ECG leads. Persistent atrial standstill secondary to acute myocarditis is extremely rare.
CASE REPORT
10-year-old girl had atrial standstill and heart failure due to acute myocarditis. After recovery from myocarditis, heart failure resolved, but the atrial standstill persisted.
OUTCOME
Persistent atrial standstill was treated with permanent pacemaker and anticoagulation.
MESSAGE
Acute myocarditis may rarely cause atrial standstill that can last even after recovery from myocarditis.
Topics: Arrhythmias, Cardiac; Child; Echocardiography, Doppler; Female; Heart Atria; Heart Failure; Humans; Myocarditis; Pacemaker, Artificial
PubMed: 26897154
DOI: 10.1007/s13312-016-0814-3