Wu Zhengbo, Wu Yang, Liu Yang, Hu Jiqiang
Graduate School, Beijing University of Chinese Medicine, Beijing, China.
Department of Cardiology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China.
JACC Case Rep. 2025 May 14;30(10):103873. doi: 10.1016/j.jaccas.2025.103873.
Atrial standstill (AS), a rare and diagnostically challenging cardiac disorder with total absence of atrial electrical and mechanical activity, often presents variably, mimicking atrial fibrillation (AF) in electrocardiogram (ECG). This report details a case of AS initially misdiagnosed as AF.
A 65-year-old Chinese female had 5-year intermittent palpitations. Prehospital ECG showed paroxysmal AF, and echocardiogram showed a giant atrium. A single-chamber pacemaker (ventricular pacing, ventricular sensing, inhibited) was implanted 6 months ago due to long ventricular intervals. During this hospitalization, AS was confirmed using electrophysiological examination, altering the treatment approach and prognosis.
AS is complex and overlooked. Early recognition and proper management are crucial. Accurate diagnosis via echocardiogram and electrophysiological testing is vital for at-risk patients. This case highlights the need for precise test interpretation and comprehensive evaluation for optimal patient care. AS is an infrequently encountered arrhythmia that eludes clear diagnosis using surface ECG. It is characterized by complete atrial electrical and mechanical inactivity, bradycardia, atrioventricular junction escape rhythm, and absence of P waves. Despite its rarity, patients may present with palpitations, syncope, or stroke, warranting diagnostic attention. Acquired AS can result from myocardial infiltrative diseases like amyloidosis, sarcoidosis, and hemochromatosis, as well as infections (viral myocarditis), autoimmune disorders, and certain medications. Here, we present a case of AS potentially due to long-term AF.
心房静止（AS）是一种罕见且诊断具有挑战性的心脏疾病，心房完全没有电活动和机械活动，其表现往往多变，在心电图（ECG）上可酷似心房颤动（AF）。本报告详细介绍了一例最初被误诊为AF的AS病例。
一名65岁中国女性有5年间歇性心悸病史。院前心电图显示阵发性AF，超声心动图显示巨大心房。6个月前因长心室间期植入了单腔起搏器（心室起搏、心室感知、抑制型）。在此次住院期间，通过电生理检查确诊为AS，从而改变了治疗方法和预后。
AS病情复杂且易被忽视。早期识别和恰当处理至关重要。通过超声心动图和电生理检查进行准确诊断对高危患者至关重要。本病例强调了为实现最佳患者护理而进行精确检查解读和全面评估的必要性。AS是一种罕见的心律失常，仅通过体表心电图难以明确诊断。其特征为心房完全无电活动和机械活动、心动过缓、房室交界性逸搏心律以及P波消失。尽管AS罕见，但患者可能出现心悸、晕厥或中风，值得引起诊断关注。获得性AS可由淀粉样变性、结节病和血色素沉着症等心肌浸润性疾病以及感染（病毒性心肌炎）、自身免疫性疾病和某些药物引起。在此，我们报告一例可能由长期AF导致的AS病例。
