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The total absence of atrial automaticity in a child with sinus node dysfunction

Nature Clinical Practice Cardiovascular Medicine volume 4, pages 513–517 (2007)Cite this article

Abstract

Background A routine sports evaluation identified constant alternation between a junctional and idioventricular rhythm in a 9-year-old child. During exercise testing, electrography demonstrated that the child was in junctional rhythm without any apparent P waves, and had a reduced increase in heart rate. Endocardial atrial pacing captured the atrium and demonstrated that atrioventricular conduction was normal, but the recovery time of the ectopic rhythm was very long. Three-dimensional electrophysiological mapping revealed 1:1 retrograde homogeneous conduction through the right atrium.

Investigations Electrocardiography, Holter monitoring, echocardiography, exercise stress testing, atrial pacing, three-dimensional electroanatomical mapping of the right atrium and genetic testing.

Diagnosis Sinus node dysfunction.

Management Pacemaker implantation was postponed until a later stage in the patient's development.

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Figure 1: Electrocardiograms demonstrating the total absence of atrial activity
Figure 2: Three-dimensional electroanatomical maps of the patient's right atrium, performed with the CARTO® XP Navigation System (Cordis Corporation, Miami Lakes, FL)
Figure 3: Sequential three-dimensional bipolar voltage maps of the patient's right atrium, demonstrating the progression of electrical activation (shown in red) in this chamber

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Authors and Affiliations

  1. Pediatric Cardiology Department, F Drago is Chief and G Fazio and MS Silvetti are Residents at the Arrhythmias Service, Bambino Gesù Hospital, Rome, Italy.,

    Fabrizio Drago, Giovanni Fazio & Massimo Stefano Silvetti

  2. A Di Pino is a Resident at the Cardiology Division, Taormina Hospital, Taormina, Italy.,

    Alfredo Di Pino

Authors
  1. Fabrizio Drago
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  2. Giovanni Fazio
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  3. Alfredo Di Pino
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  4. Massimo Stefano Silvetti
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Corresponding author

Correspondence to Fabrizio Drago.

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The authors declare no competing financial interests.

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Drago, F., Fazio, G., Di Pino, A. et al. The total absence of atrial automaticity in a child with sinus node dysfunction. Nat Rev Cardiol 4, 513–517 (2007). https://doi.org/10.1038/ncpcardio0966

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