Ujiro Sae, Yamashita Soichiro, Takemoto Makoto, Okuda Masanori
Department of Cardiology, Hyogo Prefectural Awaji Medical Center, 1-1-137 Shioya, Sumoto 656-0021, Japan.
Eur Heart J Case Rep. 2024 Dec 2;8(12):ytae647. doi: 10.1093/ehjcr/ytae647. eCollection 2024 Dec.
Atrial standstill is characterized by the absence of atrial activity. We report a case of a patient with extensive atrial fibrosis who underwent electrophysiologic study (EPS) and electroanatomical mapping (EAM) to identify surviving atrial sites amenable for pacemaker lead implantation.
A 72-year-old man with persistent atrial fibrillation (AF) and atrial functional mitral regurgitation/tricuspid regurgitation (MR/TR) underwent a Cox-Maze surgery, mitral and tricuspid valve repair, and biatrial plication. He was referred because of post-operative presyncope symptoms. Electrocardiography revealed atrial standstill and junctional rhythm (JR); however, EAM revealed that both atria were almost entirely scarred and isolated fibrillation in left pulmonary veins and coronary sinus. Junctional rhythm retrogradely conducted around an atrioventricular (AV) node and pacing at this area could conduct to the ventricle through the AV node. An atrial pacing lead was implanted at this area, which yielded a QRS wave similar to the own beat. However, the atrial lead voltage was quite low; hence, ventricular pacing lead was implanted to avoid a future occurrence of pacing failure.
This report demonstrates the benefits of EPS and EAM in informing optimal pacemaker implantation for patients with extensive scar in atrium.
心房静止的特征是心房活动缺失。我们报告一例患有广泛心房纤维化的患者，该患者接受了电生理研究（EPS）和电解剖标测（EAM），以确定适合植入起搏器导线的存活心房部位。
一名72岁男性，患有持续性心房颤动（AF）以及心房功能性二尖瓣反流/三尖瓣反流（MR/TR），接受了Cox迷宫手术、二尖瓣和三尖瓣修复以及双房折叠术。因术后前驱晕厥症状前来就诊。心电图显示心房静止和交界性心律（JR）；然而，EAM显示双房几乎完全瘢痕化，左肺静脉和冠状窦存在孤立性颤动。交界性心律经房室（AV）结逆行传导，在此区域起搏可通过AV结传导至心室。在此区域植入了心房起搏导线，其产生的QRS波与自身搏动相似。然而，心房导线电压相当低；因此，植入了心室起搏导线以避免未来发生起搏失败。
本报告展示了EPS和EAM在指导心房广泛瘢痕患者进行最佳起搏器植入方面的益处。
