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

Fabrizio Drago, Giovanni Fazio, Alfredo Di Pino, Massimo Stefano Silvetti

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)513-517
Number of pages5
JournalNature Clinical Practice Cardiovascular Medicine
Issue number9
Publication statusPublished - Sep 2007

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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