Park So Ra, Kwak Choong Hwan, Kang Young Ran, Seo Myung Ki, Kang Min Kyung, Cho Jung Hyun, Ahn Yeon Jeong, Hwang Jin Yong
Department of Internal Medicine, Gyeongsang National University College of Medicine, Jinju, Korea.
Yonsei Med J. 2009 Feb 28;50(1):156-9. doi: 10.3349/ymj.2009.50.1.156. Epub 2009 Feb 24.
We report a 55-year-old female patient who presented with no P waves but with a wide QRS complex escape rhythm at 44 beats/min and prolonged QTc of 0.55 seconds on ECG. The patient had recurrence of ventricular fibrillations and loss of consciousness, and underwent defibrillation and cardiopulmonary resuscitation (CPR) several times because of cardiac arrest. The transthoracic echocardiography showed dilated cardiomyopathy and enlargement of both atria. The Doppler echocardiography documented the absence of A wave in the tricuspid and mitral valve flow. An electrophysiologic study demonstrated electrical inactivity in the right and left atria. Atrial pacing with maximum output did not capture the atria. These findings together with her electrocardiographic finding indicated atrial standstill. Sudden cardiac death was her first clinical manifestation of ventricular arrhythmia. The patient remained asymptomatic after receiving a single chamber implantable cardioverter-defibrillator (ICD) with VVI pacemaker function.
我们报告了一名55岁女性患者，其心电图显示无P波，出现宽QRS波逸搏心律，心率为44次/分钟，QTc延长至0.55秒。该患者反复发生心室颤动并意识丧失，因心脏骤停多次接受除颤和心肺复苏（CPR）。经胸超声心动图显示扩张型心肌病和双房增大。多普勒超声心动图记录到三尖瓣和二尖瓣血流中A波缺失。电生理研究显示左右心房电活动消失。最大输出量的心房起搏未能夺获心房。这些发现连同其心电图表现提示心房静止。心脏性猝死是其室性心律失常的首发临床表现。该患者在接受具有VVI起搏器功能的单腔植入式心脏复律除颤器（ICD）后仍无症状。
