Partial atrial standstill: a case report

Twelve-lead electrocardiograms revealed no atrial activity and a wide QRS escape rhythm at 38 beats/min in a 20-year-old man who presented with syncope. Doppler echocardiography documented the absence of A wave both in the tricuspid and mitral valve flow. The only mechanical activity was documented at the left atrial appendage. An electrophysiologic study demonstrated electrical inactivity in the right atrium and an atrial tachycardia in the left atrium. Atrial pacing with maximum output did not capture the atria. Our case represents an advanced stage of partial atrial standstill, with a mechanical and electrical atrial activity confined only to the left trial appendage. The patient remained asymptomatic after receiving a VVIR pacemaker and anticoagulation therapy.