Patient with sick sinus syndrome and implanted dual-chamber pacemaker with reduced P-wave duration following low interatrial septal pacing: Case report.

Abstract

INTRODUCTION:

A dual-chamber pacemaker (DDD/R) for a sinus node disease is sometimes referred to as a physiological pacemaker as it maintains atrioventricular synchrony, however several clinical trials have proved its inferiority to a nonphysiological single-chamber ventricular back-up pacing.

PATIENT CONCERNS:

A subject of the study is a 74-year-old woman with a sick sinus syndrome (SSS) and a previously implanted physiological DDD/R pacemaker. The SSS was diagnosed because of patient's very slow sinus rhythm of about 36 bpm, and due to several episodes of dizziness. After the DDD/R implantation the percentage of atrial pacing approached 100%, with almost none ventricular pacing.

DIAGNOSES:

Sick sinus syndrome, complete Bachmann's bundle block, atrial fibrillation, atrial flutter.

INTERVENTIONS:

The patient was previously implanted with a physiological DDD/R pacemaker. Several years after the implantation, the atrial fibrillation was diagnosed and the pulmonary vein isolation was then performed by cryoablation. During the follow-up after pulmonary vein isolation, the improvement of mitral filling parameters was assessed using echocardiography. Shortly thereafter the patient developed the persistent paroxysm of a typical atrial flutter which was successfully terminated using a radiofrequency ablation. No recurrence thereof has been observed ever since (24 months).

OUTCOMES:

The atrial electrode of the pacing system was implanted within the low interatrial septal region that resulted in a reduced P-wave duration compared to native sinus rhythm P-waves. The said morphology was deformed because of the complete Bachmann bundle block. That approach, despite a nonphysiological direction of an atrial activation, yielded relatively short P-waves (paced P-wave: 179 ms vs intrinsic sinus P-wave: 237 ms). It also contributed to a significantly shorter PR interval (paced PR: 204 ms vs sinus rhythm PR: 254 ms).

CONCLUSIONS:

The authors took into consideration different aspects of alternative right atrial pacing sites. This report has shown that in some patients with a sinus node disease, low interatrial septal pacing can reduce the P-wave duration but does not prevent from the development of atrial arrhythmias.

• Authors: Jakub Mercik, Aleksandra Gajek-Marecka, Jacek Marcin Zawadzki, Agnieszka Sławuta, Jacek Gajek
• Journal: Medicine (Medicine (Baltimore)) Vol. 100 Issue 35 Pg. e27076 (Sep 03 2021) ISSN: 1536-5964 [Electronic] United States
• PMID: 34477142 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

Topics

• Aged
• Arrhythmias, Cardiac (etiology, therapy)
• Cardiac Pacing, Artificial (adverse effects, methods, statistics & numerical data)
• Cardiac Resynchronization Therapy Devices (standards, statistics & numerical data)
• Female
• Humans
• Sick Sinus Syndrome (physiopathology, therapy)