Concealed Sinus Node Dysfunction and Paradoxical Effect of Atropine during Arrhythmia Diagnostic Pharmacological Testing | Zendy

Myriam Karam | Zendy; Antoine Kossaify | Zendy

Open Access

Concealed Sinus Node Dysfunction and Paradoxical Effect of Atropine during Arrhythmia Diagnostic Pharmacological Testing

Author(s) -

Myriam Karam,

Antoine Kossaify

Publication year - 2014

Publication title -

clinical medicine insights case reports

Language(s) - English

Resource type - Journals

SCImago Journal Rank - 0.187

H-Index - 12

ISSN - 1179-5476

DOI - 10.4137/ccrep.s18122

Subject(s) - bigeminy , atropine , medicine , junctional rhythm , bradycardia , cardiology , rhythm , sinus bradycardia , anesthesia , sinus rhythm , sinus (botany) , normal sinus rhythm , sinoatrial node , fainting , sick sinus syndrome , heart rate , blood pressure , atrial fibrillation , botany , genus , biology , ventricular tachycardia

A 78-year-old male patient presented with repetitive fainting episodes. His electrocardiogram showed sinus rhythm with persistent ventricular bigeminy. Concealed sinus node dysfunction (SND) with consecutive bradycardia-induced ventricular hyperexcitability was suspected. Pharmacological testing with atropine resulted in accelerated junctional rhythm along with nearly total disappearance of the ventricular ectopy. The diagnosis of SND was retained, a dual chamber pacemaker was implanted, and consequently, ventricular hyperexcitability disappeared. The junctional rhythm was a paradoxical effect of atropine, and many explanations were provided. Discussion was made accordingly taking into account relevant data from the literature.

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