Türkoğlu Cengizhan, Aliyev Farid, Celiker Cengiz, Fıratlı Inci
Department of Cardiology, Division of Pacing and Electrophysiology, İstanbul University Institute of Cardiology, İstanbul, Turkey.
Turk Kardiyol Dern Ars. 2011 Jan;39(1):55-8.
We present an interesting case of 'pseudo' atrial fibrillation which was further diagnosed as atrial standstill with irregular junctional ectopic rhythm during electrophysiologic study. A 56-year-old woman presented to a health facility with symptoms of palpitation, lightheadedness, and shortness of breath. Upon detection of irregular rhythm with narrow QRS complexes and no visible P waves on the electrocardiogram, newly developed atrial fibrillation was considered and a direct current cardioversion was performed, during which cardiac asystole developed necessitating cardiopulmonary resuscitation. The patient was then transferred to our institution. Echocardiographic examination showed biatrial dilatation, normal left ventricular systolic function, marked left ventricular hypertrophy, severe aortic stenosis, moderate mitral regurgitation, and severe tricuspid regurgitation. The electrocardiogram showed an irregular rhythm with narrow QRS complexes without any fibrillatory f waves and 24-hour Holter monitoring revealed three episodes of ventricular asystole lasting for more than 3.5 seconds. During the electrophysiologic study, no electrical activity was observed at the high and low levels of the right atrial lateral free wall and septal wall. The final diagnosis was established as atrial standstill and irregular junctional ectopic rhythm. The patient refused aortic valve replacement and died due to progression of the underlying disease one year following permanent pacemaker implantation..
我们报告一例有趣的“假性”心房颤动病例，在电生理研究中进一步诊断为心房停搏伴不规则交界性异位心律。一名56岁女性因心悸、头晕和呼吸急促症状前往一家医疗机构就诊。心电图检测到QRS波群狭窄的不规则心律且未见明显P波，考虑为新发心房颤动并进行了直流电复律，期间出现心脏停搏，需要进行心肺复苏。随后患者被转至我院。超声心动图检查显示双房扩大、左心室收缩功能正常、左心室显著肥厚、重度主动脉瓣狭窄、中度二尖瓣反流和重度三尖瓣反流。心电图显示QRS波群狭窄的不规则心律，无任何颤动波，24小时动态心电图监测发现3次心室停搏发作，持续时间超过3.5秒。在电生理研究中，右心房外侧游离壁和间隔壁的高低部位均未观察到电活动。最终诊断为心房停搏和不规则交界性异位心律。患者拒绝主动脉瓣置换，在植入永久性起搏器一年后因基础疾病进展而死亡。
