A case of atrial standstill with the atrial lead of a dual-chamber pacemaker implanted in the coronary sinus

Abstract

Atrial standstill (AS) is a rare condition characterized by the absence of electrical and mechanical atrial activity,1 first described by Cushny.2 The absence of P waves and bradycardia, along with a wide QRS complex, are seen on the electrocardiogram (ECG). The clinical course of AS varies greatly; the timeline can be persistent or transient, and the spatial distribution of the atrial lesion can be diffuse or partial.3, 4 In many cases, the AS appears initially in the right atrium (RA) and progresses to the entire left atrium. It occasionally complicates symptomatic sick sinus syndrome.5 \n \nWe hereby describe a case of AS where a dual-chamber permanent pacemaker implantation was necessary owing to symptomatic sick sinus syndrome. An electrophysiological study (EPS) revealed inactivity throughout almost the entire RA, with the exception of the coronary sinus (CS). A permanent atrial lead was therefore placed in the CS.