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Atrial Standstill

Sino-Auricular Heart Block


Presentation

  • Abstract In patients with congenital heart disease presenting with bradyarrhythmia, many electrophysiological abnormalities are found.[ncbi.nlm.nih.gov]
  • CONCLUSION: Partial atrial standstill may be present and prevent atrial lead implantation in patients with sinus node disease.[ncbi.nlm.nih.gov]
  • Underlying heart disease was present in nine patients and two cases were idiopathic. Major clinical symptoms in the 11 cases included Adams-Stokes attacks, and dyspnea on exertion.[ncbi.nlm.nih.gov]
  • Abstract Persistent atrial standstill complicating inflammatory myocarditis in a young boy is presented.[ncbi.nlm.nih.gov]
  • Abstract A patient with Kugelberg-Welander syndrome associated with junctional rhythm and restrictive cardiomyopathy is presented. An electrophysiologic study was performed.[ncbi.nlm.nih.gov]
Amyloidosis
  • One of these with amyloidosis died suddenly. One is lost to follow-up. The others cases are persisting with PAS.[ncbi.nlm.nih.gov]
  • Abstract Two cases of atrial standstill are presented, one with cardiac amyloidosis, the other with idiopathic dilated cardiomyopathy.[ncbi.nlm.nih.gov]
  • Atrial standstill has been associated with several conditions including, but not restricted to, congenital heart disease, valvular heart disease, conduction disturbances, Brugada syndrome, myocardial infarction, and amyloidosis.[ncbi.nlm.nih.gov]
  • It has been described in a few cases of long-standing valvular disease, amyloidosis, myocarditis, and muscular dystrophy. We report on a young female with noncompaction cardiomyopathy that progressed to congestive heart failure.[ncbi.nlm.nih.gov]
  • Etiologies described in the literature have included muscular dystrophy, familial amyloidosis, and rarely myocarditis. These etiologies usually lead to permanent atrial standstill and require ventricular pacing.[ncbi.nlm.nih.gov]
Asymptomatic
  • Thus, persistence of atrial standstill in asymptomatic cardiomyopathy is a sign of poor prognosis.[ncbi.nlm.nih.gov]
  • Abstract An asymptomatic patient with cardiomegaly caused by isolated right atrial standstill is reported. The right atrium showed no evidence of contraction on pressure records or angiographically, while the left atrium functioned normally.[ncbi.nlm.nih.gov]
  • The patient remained asymptomatic after receiving a VVIR pacemaker and anticoagulation therapy.[ncbi.nlm.nih.gov]
  • Following the implantation of an epicardial ventricular pacemaker, the patient became completely asymptomatic despite the persistence of electrical and mechanical atrial standstill.[ncbi.nlm.nih.gov]
  • The patient remained asymptomatic after receiving a single chamber implantable cardioverter-defibrillator (ICD) with VVI pacemaker function. KEYWORDS: Atrial standstill; cardiopulmonary resuscitation; dilated cardiomyopathy; sudden cardiac death[ncbi.nlm.nih.gov]
Cardiomegaly
  • Abstract An asymptomatic patient with cardiomegaly caused by isolated right atrial standstill is reported. The right atrium showed no evidence of contraction on pressure records or angiographically, while the left atrium functioned normally.[ncbi.nlm.nih.gov]
  • Chest X-ray revealed marked cardiomegaly with right and left chamber enlargement. Echocardiography showed massively dilated right and left atria along with mild tricuspid and mitral regurgitation.[synapse.koreamed.org]
  • There was mild pulmonary edema, with Kerley's B lines on chest films, without evidence of cardiomegaly.[nejm.org]
Muscular Atrophy
  • atrophy Type III) Myocarditis Atrial standstill Atrial standstill may be partial or complete.[metealpaslan.com]
Myopathy
  • Abstract A case of persistent atrial standstill associated with muscular dystrophy of the limb girdle type is reported for the first time in the literature, In spite, of advanced myopathy, the patient delivered an apparently normal child.[ncbi.nlm.nih.gov]
Peripheral Neuropathy
  • Neither patient had peripheral neuropathy, gastrointestinal disorder, or renal dysfunction. Familial atrial standstill is usually associated with peripheral neuropathy.[ncbi.nlm.nih.gov]
Uremia
  • Abstract A 55 year old man with hypertensive cardiovascular disease and uremia was studied. Atrial standstill was confirmed by intracardiac electrocardiography and by inability to stimulate the atria using intraatrial cardiac electrical pacing.[ncbi.nlm.nih.gov]

Workup

Hyponatremia
  • Patients with atrial standstill were older (P 0.036), had lower diastolic blood pressure (DBP; P CONCLUSIONS: Hyponatremia and decline in DBP are associated with atrial standstill in patients with hyperkalemia. (Circ J 2016; 80: 1781-1786).[ncbi.nlm.nih.gov]

Treatment

  • 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.[ncbi.nlm.nih.gov]
  • The importance of the examination of His bundle electrography in persistent atrial standstill and the diagnostic criteria and treatment of this lesion are discussed.[ncbi.nlm.nih.gov]
  • In the patient with amyloidosis (ANP: 170 pg/ml, BNP: 1220 pg/ml), a dual chamber pacemaker was successfully implanted for the treatment of sinus arrest. However, loss of atrial capture occurred 1 month later.[ncbi.nlm.nih.gov]
  • Subject Dogs -- Diseases -- Treatment -- Case studies[ecommons.cornell.edu]
  • Modalities 729 Treatment Modalities 731 Clinical Role of Antiarrhythmic Drugs in the Prevention of Sudden Death 733 Nonantiarrhythmic Drugs in Sudden Death Prevention 760 The Implantable Cardioverter Defibrillator Technical and Clinical Considerations[books.google.com]

Prognosis

  • Thus, persistence of atrial standstill in asymptomatic cardiomyopathy is a sign of poor prognosis.[ncbi.nlm.nih.gov]
  • Oechslin EN, Jost CHA, Rojas JR, Kaufinann PA, Jenni R (2000) Long-term follow-up of 34 adults with isolated left ventricular noncompaction; a distinct cardiomyopathy with poor prognosis.[link.springer.com]
  • Symptomatic cases require ventricular pacing and treatment for congestive heart failure if present, however, the prognosis is poor.[synapse.koreamed.org]

Etiology

  • Etiologies described in the literature have included muscular dystrophy, familial amyloidosis, and rarely myocarditis. These etiologies usually lead to permanent atrial standstill and require ventricular pacing.[ncbi.nlm.nih.gov]
  • The etiology of atrial paralysis in this case remains unknown; the etiopathogenesis of this rare disorder is discussed.[ncbi.nlm.nih.gov]
  • Abstract Electrophysiologic studies including His bundle recording, atrial, and ventricular stimulation, were performed in three symptomatic patients with persistent atrial standstill of unknown etiology.[ncbi.nlm.nih.gov]
  • Electrolyte disturbances, vasovagal reflexes from the upper part of the gastrointestinal tract, and hypoxia have all been implicated as temporary etiological factors.[jamanetwork.com]
  • However, the main etiology remained unknown as our patient did not give consent for a genetic evaluation. In such patients, implanting a PPM is thought to confer a better life style and symptom reduction. 3 References 2.[ncbi.nlm.nih.gov]

Epidemiology

  • Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham study . Neurology 1978 ;28: 973 –7. 23. Woolliscroft J, Tuna N. . Permanent atrial standstill: the clinical spectrum . Am J Cardiol 1982 ;49: 2037 –41. 24.[nejm.org]
Sex distribution
Age distribution

Pathophysiology

  • Abstract Persistent atrial standstill is a very rare pathophysiologic condition whose diagnosis is established when both electrical and mechanical silence of the atria are confirmed.[ncbi.nlm.nih.gov]
  • […] atrial systolic function, manifested by a characteristic transmitral Doppler spectral velocity profile, has previously been termed "atrial failure" 8 and has portended a poor outcome in patients with the primary form of the disease. 9 The underlying pathophysiologic[nejm.org]

Prevention

  • […] of Sudden Death 733 Nonantiarrhythmic Drugs in Sudden Death Prevention 760 The Implantable Cardioverter Defibrillator Technical and Clinical Considerations 772 Beyond Sudden Death Prevention Minimizing Implantable Cardioverter Defibrillator Shocks and[books.google.com]
  • CONCLUSION: Partial atrial standstill may be present and prevent atrial lead implantation in patients with sinus node disease.[ncbi.nlm.nih.gov]
  • Fibrosis prevents proper conduction and so ventricular contraction occurs in the form of escape beats , and thus the heart rate is slow. ECG examination usually reveals an absence of P waves and may show a widening of the QRS complex.[cal.vet.upenn.edu]
  • Hemodynamic collapse was prevented by pacing from the coronary sinus ( Figure 2d ).[innovationsincrm.com]
  • […] less than a week Lifestyle changes Medication to control your heart rate: beta-blockers, calcium channel blockers, digoxin Procedure to control your heart rate (if medication fails) Pulmonary vein isolation Radiofrequency ablation Anticoagulants to prevent[webmd.com]

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