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

Nat Clin Pract Cardiovasc Med. 2007 Sep;4(9):513-7. doi: 10.1038/ncpcardio0966.


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.

Publication types

  • Case Reports

MeSH terms

  • Accelerated Idioventricular Rhythm / diagnosis*
  • Child
  • Electrocardiography
  • Electrocardiography, Ambulatory
  • Electrophysiologic Techniques, Cardiac
  • Heart Atria / physiopathology*
  • Heart Conduction System / physiopathology*
  • Heart Rate
  • Humans
  • Male
  • Sinoatrial Node / physiopathology*